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ABSTRACT The CONVINCE study, recently published in the New England Journal of Medicine, reveals a groundbreaking 23% reduction in the relative risk of all-cause mortality among end-stage kidney patients undergoing high convective volume hemodiafiltration. This significant finding challenges the conventional use of high-flux hemodialysis and offers hope for improving outcomes in chronic kidney disease patients. While some controversies surround the study's findings, including concerns about generalizability and the causes of death, it is essential to acknowledge the study's design and its main outcomes. The CONVINCE study, part of the HORIZON 2020 project, enrolled 1360 patients and demonstrated the superiority of hemodiafiltration in reducing all-cause mortality overall, as well as in specific patient subgroups (elderly, short vintage, non-diabetic, and those without cardiac issues). Interestingly, it was shown that hemodiafiltration had a protective effect against infection, including COVID-19. Future research will address sustainability, dose scaling effects, identification of subgroups especially likely to benefit and cost-effectiveness. However, for now, the findings strongly support a broader adoption of hemodiafiltration in renal replacement therapy, marking a significant advancement in the field.

RESUMO O estudo CONVINCE, publicado recentemente no New England Journal of Medicine, revela uma redução inovadora de 23% no risco relativo de mortalidade por todas as causas entre pacientes renais em estágio terminal submetidos à hemodiafiltração de alto volume de convecção. Esse achado significativo desafia o uso convencional da hemodiálise de alto fluxo e oferece esperança de melhoria dos desfechos em pacientes com doença renal crônica. Embora algumas controvérsias cerquem os achados do estudo, incluindo preocupações sobre a generalização e as causas de óbito, é essencial reconhecer o desenho do estudo e seus principais desfechos. O estudo CONVINCE, parte do projeto HORIZON 2020, inscreveu 1.360 pacientes e demonstrou a superioridade da hemodiafiltração na redução da mortalidade por todas as causas em geral, bem como em subgrupos específicos de pacientes (idosos, HD de curta duração, não diabéticos e aqueles sem problemas cardíacos). Curiosamente, demonstrou-se que a hemodiafiltração teve um efeito protetor contra infecções, incluindo a COVID-19. Pesquisas futuras abordarão sustentabilidade, efeitos de escalonamento da dose, identificação de subgrupos especialmente propensos a se beneficiar e a relação custo-benefício. No entanto, por ora, os achados apoiam fortemente uma adoção mais ampla da hemodiafiltração na terapia renal substitutiva, marcando um avanço significativo na área.

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ABSTRACT Online hemodiafiltration (HDF) is a rapidly growing dialysis modality worldwide. In Brazil, the number of patients with private health insurance undergoing HDF has exceeded the number of patients on peritoneal dialysis. The achievement of a high convection volume was associated with better clinical imprand patient - reported outcomes confirming the benefits of HDF. The HDFit trial provided relevant practical information on the implementation of online HDF in dialysis centers in Brazil. This article aims to disseminate technical information to improve the quality and safety of this new dialysis modality.

RESUMO A hemodiafiltração (HDF) on-line é uma modalidade dialítica em rápido crescimento no mundo. No Brasil, o número de pacientes com planos de saúde privados tratados por HDF já ultrapassa aquele de pacientes em diálise peritoneal. O alcance de um alto volume convectivo associado à redução de desfechos clínicos e do risco de morte confirmam os benefícios da HDF. Dados nacionais do estudo HDFit forneceram informações práticas relevantes sobre a implementação da HDF on-line em clínicas de diálise no Brasil. O objetivo desta publicação é a disseminação de informações técnicas que possam auxiliar na utilização, com qualidade e segurança, dessa nova modalidade dialítica.

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PURPOSE: Considering the importance of incorporating quality of life (QoL) construct during the health care of patients with stage 5 chronic kidney disease (CKD) on dialysis, it is necessary to have evidence on the clinimetric properties of the instruments used for its measurement. This study aimed to establish the clinimetric properties of the Kidney Disease Quality of Life Short Form 36 (KDQOL-36) scale in patients with stage 5 CKD on dialysis in Colombia. METHODS: A scale validation study was conducted using the classical test theory methodology. The statistical analysis included exploratory factor analysis (EFA) and confirmatory (CFA) techniques performed on two independent subsamples; concurrent criterion validity assessments; internal consistency using four different coefficients; test-retest reliability; and sensitivity to change using mixed model for repeated measures. RESULTS: The KDQOL-36 scale was applied to 506 patients with a diagnosis of stage 5 CKD on dialysis, attended in five renal units in Colombia. The EFA endorsed the three-factor structure of the scale, and the CFA showed an adequate fit of both the original and empirical models. Spearman's correlation coefficient values ≥0.50 were found between the domains of the CKD-specific core of the KDQOL-36 scale and the KDQ. Cronbach's alpha, McDonald's omega, Greatest lower bound (GLB), and Guttman's lambda coefficients were ≥0.89, indicating a high degree of consistency. A high level of concordance correlation was found between the two moments of application of the instrument, with values for Lin's concordance correlation coefficient ≥0.7. The application of the instrument after experiencing an event that could modify the quality of life showed statistically significant differences in the scores obtained. CONCLUSION: The KDQOL-36 scale is an adequate instrument for measuring QoL in Colombian patients with stage 5 CKD on dialysis.

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ABSTRACT Introduction Chronic kidney disease is a progressive and irreversible loss of kidney function and considerably affects the lives of patients and their families. Its high incidence necessitates efficient public policies for prevention and treatment. However, policies for chronic kidney disease education and awareness are scarce. Objective To evaluate global public policies for the prevention and treatment of chronic kidney disease adopted in various regions, aiming to comprehend the differences between various models. Methods This integrative review followed PRISMA recommendations and included papers published between 2016 and 2021 across several databases. Results The 44 selected articles were categorized into three themes: structural and financial aspects of the organization of renal healthcare, access to renal healthcare or management of chronic kidney disease, and coping strategies for chronic kidney disease or kidney health. Critical analysis of the papers revealed global neglect of kidney disease in political agendas. Considerable policy variations exist between different countries and regions of the same country. Our research highlighted that free and universal health coverage, especially for the most vulnerable patients, is crucial for accessing treatment owing to the prohibitively high treatment costs. Conclusion Social, economic, and ethnic inequalities strongly correlate with disease occurrence, primarily affecting minority groups who lack health support, especially for the prevention and treatment of chronic kidney disease.

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Objetivo: mapear os Diagnósticos de Enfermagem da taxonomia NANDA-I validados para pacientes renais crônicos submetidos a hemodiálise. Método: revisão de escopo registrada no Open Science Framework, guiada pelo método JBI e norteada pelo Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. As buscas foram realizadas nas bases Medical Literature Analysis and Retrievel System, Cummulative Index to Nursing and Allied Health Literature, entre outras, além da literatura cinzenta. Dados analisados descritivamente. Não houve recorte temporal ou idiomático. Resultados: identificados 12 estudos com 6 Diagnósticos de Enfermagem validados para pacientes renais crônicos submetidos a hemodiálise: volume de líquidos excessivo, proteção ineficaz, autogestão ineficaz da saúde, espiritualidade prejudicada, disposição para melhora da esperança e hipotermia. Conclusão: o mapeamento dos Diagnósticos de Enfermagem da taxonomia NANDA-I mostrou que a qualidade do processo de enfermagem tende a melhorar, quando diagnósticos de enfermagem são validados, conferindo maior confiabilidade e segurança à prática clínica.

Objetivo: mapear los Diagnósticos de Enfermería de la taxonomía NANDA-I validados para pacientes renales crónicos sometidos a hemodiálisis. Método: Revisión de ámbito registrada en el Open Science Framework, guiada por el método JBI y guiada por el Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Las búsquedas fueron realizadas en las bases Medical Literature Analysis and Retrieval System, Cumulative Index to Nursing and Allied Health Literature, entre otras, además de la literatura gris. Datos analizados descriptivamente. No hubo recorte temporal o idiomático. Resultados: identificados 12 estudios con 6 Diagnósticos de Enfermería validados para pacientes renales crónicos sometidos a hemodiálisis: volumen de líquidos excesivo, protección ineficaz, autogestión ineficaz de la salud, espiritualidad perjudicada, disposición para mejorar la esperanza y la hipotermia. Conclusión: el mapeo de los Diagnósticos de Enfermería de la taxonomía NANDA-I mostró que la calidad del proceso de enfermería tiende a mejorar, cuando diagnósticos de enfermería son validados, confiriendo mayor confiabilidad y seguridad a la práctica clínica.

Objective: to map the Nursing Diagnoses of the NANDA-I taxonomy validated for chronic kidney disease patients undergoing hemodialysis. Method: scope review recorded in the Open Science Framework, guided by the JBI method and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. The searches were performed in the Medical Literature Analysis and Retrieval System, Cumulative Index to Nursing and Allied Health Literature, among others, besides the gray literature. Data analyzed descriptively. There was no temporal or idiomatic cut. Results: 12 studies were identified with 6 validated Nursing Diagnoses for chronic kidney disease patients undergoing hemodialysis: excessive volume of fluids, ineffective protection, ineffective health self-management, impaired spirituality, willingness to improve hope and hypothermia. Conclusion: the mapping of Nursing Diagnoses of the NANDA-I taxonomy showed that the quality of the nursing process tends to improve when nursing diagnoses are validated, giving greater reliability and safety to clinical practice.

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ABSTRACT Objective: This two-centre cross-sectional study aimed to evaluate whether xerostomia occurrence is associated with oral health-related quality of life (OHRQoL) in patients with end-stage renal disease (ESRD) after the adjustment for potential confounders. Methods: Oral examinations were performed by calibrated examiners for untreated dental caries, periodontitis and tooth loss in 180 adults with ESRD. The presence of xerostomia was determined using the global question "How often does your mouth feel dry?". OHRQoL was evaluated by the simplified version of the Oral Health Impact Profile (OHIP14) questionnaire. Multivariate zero-inflated negative binomial regression analysis was used to calculate the incidence rate ratios (IRR) for the nonzero scores and odds ratios (OR) of having no impact in OHIP14 scores according to the presence of exposure. Results: In the adjusted model, xerostomia (IRR = 1.57; 95% CI: 1.12 to 2.20) was associated with poorer OHRQoL. The adjusted domain-specific analysis revealed that xerostomia occurrence significantly impacted the psychological disability and social disability, and the chance of having no impact was lower for the psychological discomfort domain (OR = 0.84; 95% CI: 0.12 to 0.98). Conclusion: Xerostomia exert an impact on OHRQoL in patients with ESRD, mainly in the psychological and social disabilities constructs.

RESUMO Objetivo: Este estudo transversal realizado em dois centros teve como objetivo avaliar se a ocorrência de xerostomia está associada à qualidade de vida relacionada à saúde bucal (QVRSB) em pacientes com doença renal crônica em estágio final (DRCEF) após o ajuste para potenciais fatores de confusão. Métodos: Exames bucais foram realizados por examinadores calibrados para cárie dentária não tratada, periodontite e perda dentária em 180 adultos com DRCEF. A presença de xerostomia foi determinada por meio da pergunta global "Com que frequência você fica com a boca seca?". A QVRSB foi avaliada pela versão simplificada do questionário Oral Health Impact Profile (OHIP-14). A análise multivariada de regressão binomial negativa inflacionada por zero foi usada para calcular as taxas de incidência (IRR) para os escores diferentes de zero e os razões de chance (OR) de não haver impacto nos escores do OHIP-14 de acordo com a presença dA exposição. Resultados: No modelo ajustado, a xerostomia (IRR = 1,57; IC 95%: 1,12 a 2,20) foi associada a pior QVRSB. A análise específica por domínio revelou que a ocorrência de xerostomia impactou significativamente a incapacidade psicológica e a incapacidade social, e a chance de não haver impacto foi menor para o domínio desconforto psicológico (OR = 0,84; IC95%: 0,12 a 0,98). Conclusão: A xerostomia exerce impacto sobre a QVRSB em pacientes com DRCEF, principalmente nos construtos de deficiência psicológica e social.

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Methods. This is a randomized controlled trial study on 52 caregivers of hemodialysis patients referred an universitary hospital at Jahrom. The caregivers were randomly divided into intervention and control groups. In the intervention group, Benson's relaxation was performed twice a day for 15 minutes each time, and continued for one month. Data collection tools included demographic information questionnaire and standard Zarit Burden Interview questionnaire which was completed by all participants before the intervention and one month after it. Results. After the intervention, the mean caregiver burden of hemodialysis patients in the intervention group decreased significantly compared to the control group (p<0.001). The results of paired t-test showed that in the intervention group, the mean scores of caregiver burden after the intervention (14.46± 10.91) was significantly lower than before the intervention (38.33±16.94) (p=0.001). Conclusion. Benson's relaxation method can reduce caregiver burden in caregivers of hemodialysis patients.

Objetivo. Investigar el efecto de la técnica de relajación de Benson sobre la carga de los cuidadores de pacientes en hemodiálisis. Métodos. Estudio de intervención realizado con la participación de 52 cuidadores de pacientes en hemodiálisis remitidos a un hospital universitario de Jahrom (Iran). Los cuidadores fueron divididos aleatoriamente en los grupos de intervención y de control. En el grupo de intervención, se realizó la técnica de relajación de Benson dos veces al día durante 15 minutos cada vez, y se continuó durante un mes. Las herramientas de recogida de datos incluían un cuestionario de información demográfica y la entrevista de percepción de carga del cuidador "Zarit Burden Interview" que fue completado por todas participantes antes de la intervención y un mes después de terminada la misma. Resultados. Después de la intervención, la carga media de los cuidadores de pacientes en hemodiálisis en el grupo de intervención disminuyó significativamente en comparación con el grupo de control (p<0.001). Los resultados de la prueba t pareada mostraron que en el grupo de intervención, las puntuaciones medias de la carga del cuidador después de la intervención (14.46±10.91) fueron significativamente menores que antes de la intervención (38.33±16.94) (p=0.001). Conclusión. El método de relajación de Benson puede reducir la carga de los cuidadores de pacientes en hemodiálisis.

Objetivo. Investigar o efeito do relaxamento de Benson na sobrecarga do cuidador em cuidadores de pacientes em hemodiálise na cidade de Jahrom. Métodos. Este é um estudo controlado randomizado envolvendo 52 cuidadores de pacientes em hemodiálise encaminhados a um hospital afiliado à Jahrom University of Medical Sciences. Os cuidadores foram divididos aleatoriamente em grupos intervenção (n=24) e controle (n=24). No grupo intervenção, os cuidadores realizaram o relaxamento de Benson duas vezes ao dia por 15 minutos cada, e foi continuado por um mês. A coleta de informações incluiu um questionário de informações demográficas e o questionário padrão Zarit que foi preenchido por todos os participantes antes da intervenção e um mês após o seu preenchimento. Resultado S. A maioria dos cuidadores nos grupos intervenção (79.2%) e controle (64.3%) eram mulheres. Após a intervenção, a sobrecarga média dos cuidadores de pacientes em hemodiálise no grupo intervenção diminuiu significativamente em relação ao grupo controle (p<0.001). Os resultados do teste t pareado mostraram que, apenas no grupo intervenção, os escores médios de sobrecarga do cuidador após a intervenção (14.46 ±10.1) foram significativamente menores do que antes da intervenção (38.33) ±16.94) com p <0.001. Conclusão. O método de relaxamento de Benson demonstrou ser eficaz na redução da sobrecarga dos cuidadores de pacientes em hemodiálise.

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Abstract We present a 9-year-old patient with end-stage renal disease, on peritoneal dialysis, who underwent a staged prone retroperitoneoscopic bilateral nephrectomy. Bilateral nephrectomy was indicated in preparation for renal transplant in the context of genetic predisposition malignancy when immunosuppressed. The two mirror-image surgeries enable the comparison of the anesthetic management and outcomes in a single patient. Features of interest to anesthesiologists include approach to a child with chronic kidney disease, different requirements for intraoperative antihypertensives; pain management strategies, including a comparison of erector spinae plane block with and without adjunct dexmedetomidine; anesthetic management of retroperitoneoscopic pediatric surgery and the first description of using a Foley bag attached to a peritoneal dialysis catheter to aid in diagnosis and repair of posterior peritoneal cavity entry.

Resumen Se presenta un paciente de 9 años de edad con enfermedad renal terminal, en diálisis peritoneal, quien se sometió a nefrectomía bilateral retroperitoneoscópica estadificada en posición prona. Se indicó la nefrectomía bilateral en preparación para trasplante renal en el contexto de predisposición genética hacia desarrollar una patología maligna al estar inmunosuprimido. Las dos cirugías en espejo permiten hacer una comparación del manejo anestésico y de los desenlaces en un mismo paciente. Las características de interés para los anestesiólogos incluyen el abordaje de un niño con enfermedad renal crónica, con requisitos diferentes de antihipertensivos intraoperatorios; estrategias para el manejo del dolor, incluyendo una comparación de bloqueo del plano del erector espinal con y sin dexmedetomidina adyuvante; manejo anestésico de cirugía pediátrica retroperitoneoscópica y la primera descripción del uso de una bolsa Foley conectada a un catéter de diálisis peritoneal para ayudar en el diagnóstico y la reparación de la entrada de la cavidad peritoneal posterior.

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Introdução: o objetivo foi avaliar a prevalência do distúrbio mineral e ósseo em pacientes com doença renal crônica e a associação entre Taxa de Filtração Glomerular estimada (TFGe) e os indicadores do distúrbio mineral e ósseo (DMO) (cálcio, fósforo e PTH) em pacientes renais crônicos não dialíticos. Materiais e Métodos: estudo seccional da linha de base de uma coorte de dois anos, com adultos e idosos renais crônicos em tratamento conservador. Para identificação do DMO utilizamos os seguintes valores séricos: PTH (> 150 pg/mL) e/ou hipocalcemia (Ca < 8,8mg/dl) e/ou hiperfosfatemia (P > 4,6 mg/dl). Na análise estatística utilizou-se: regressão de Poisson; T de Student, Mann Whitney e correlações de Pearson e Spearman. Nível de significância foi de 5%. Resultados: prevalência de DMO de 54,6% (n=41) (IC 95%: 43,45 - 65,43). A maior prevalência de DMO foi em pessoas do sexo feminino, alfabetizadas, idosas, não etilistas, não tabagistas, sedentárias e de cor de pele branca, porém, sem diferença estatística entre os grupos com e sem DMO. As correlações entre P e PTH com TFGe foram significativas, inversas, de força moderada (p= <0,005 e p = 0,003; coeficientes de correlação = - 0,312 e - 0,379 respectivamente). Discussão:os achados desse estudo mostraram que existe uma lacuna no acompanhamento do DMO-DRC pela atenção primária e a prática clínica deve ser revista. Conclusão:identificou-se prevalência robusta de DMO nos estágios precoces da DRC, além de correlações significativas entre o aumento dos níveis de fósforo e PTH e piora das funções renais.

Introduction: mineral and bone disorder (BMD) is a serious complication of chronic kidney disease (CKD) that increases risks for death from cardiovascular causes and impairs quality of life of affected patients. Objetive: to evaluate the prevalence of BMD in patients with CKD and the association between estimated Glomerular Filtration Rate (eGFR) and BMD indicators (calcium, phosphorus and PTH) in non-dialysis patients. Materials and Methods:sectional study of a two-year cohort of chronic renal adults and elderly patients on conservative treatment. BMD was identified by serum values of: PTH (> 150 pg/mL) and/or hypocalcemia (Ca < 8.8mg/dl) and/or hyperphosphatemia (P > 4.6 mg/dl). The statistical analysis used: Poisson regression; Student's T, Mann Whitney and Pearson and Spearman correlations with 5% significance level. Results:BMD prevalence was 54.6% (n=41) (95% CI: 43.45 - 65.43), more frequent in women, literate, elderly, non-drinkers, non-smokers, sedentary and white skin color. Correlations between P and PTH with GFRe were significant, inverse, moderate strength (p= <0.005 and p = 0.003; correlation coefficients = - 0.312 and - 0.379 respectively). Discussion: the findings of this study highlighted gaps in the monitoring of BMD-DRC by primary care, requiring a review of clinical practices. Conclusion: robust prevalence of BMD in the early stages of CKD was identified, in addition to correlations between increased phosphorus and PTH levels and worsening kidney function.

Introducciòn: el trastorno mineral y óseo (TMO) es una complicación grave de la enfermedad renal crónica (ERC) que aumenta el riesgo de muerte por causas cardiovasculares y deteriora la calidad de vida de los pacientes afectados. Objetivo: evaluar la prevalencia de la DMO en pacientes con RDC y la asociación entre la tasa de filtración glomerular estimada (TFGe) y los indicadores de DMO (calcio, fósforo y PTH) en pacientes no dialíticos. Materiales y Métodos: estudio seccional de una cohorte de dos años de pacientes renales crónicos adultos y ancianos en tratamiento conservador. La DMO se identificó por los valores séricos de: PTH (> 150 pg/mL) y/o hipocalcemia (Ca < 8,8mg/dl) y/o hiperfosfatemia (P > 4,6 mg/dl). El análisis estadístico utilizado: regresión de Poisson; T de Student, Mann Whitney y correlaciones de Pearson y Spearman con un nivel de significación del 5%. Resultados: la prevalencia de DMO fue del 54,6% (n=41) (IC 95%: 43,45 - 65,43), más frecuente en mujeres, alfabetizadas, de edad avanzada, no bebedoras, no fumadoras, sedentarias y de color de piel blanca. Las correlaciones entre el P y la PTH con el GFRe fueron significativas, inversas, de fuerza moderada (p= <0,005 y p = 0,003; coeficientes de correlación = - 0,312 y - 0,379 respectivamente). Discusión: los resultados de este estudio evidencian lagunas en el seguimiento de la DMO-DRC por parte de la atención primaria, lo que requiere una revisión de las prácticas clínicas. Conclusión: se identificó una fuerte prevalencia de la DMO en las primeras fases de la ERC, además de correlaciones entre el aumento de los niveles de fósforo y PTH y el empeoramiento de la función renal.

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Introducción: las alteraciones del metabolismo óseo-mineral, son una causa importante de morbilidad en los pacientes con trasplante renal, por lo que el manejo de las complicaciones del paciente trasplantado, a largo plazo, deben de ser seguidas. El estudio intenta demostrar cambios en el metabolismo óseo y mineral en pacientes con enfermedad renal crónica sometidos a trasplante renal en el Hospital General Plaza de la Salud durante el período comprendido entre enero 2010 ­ agosto 2018, Santo Domingo, República Dominicana. Método: estudio observacional, descriptivo, retrospectivo y transversal de 131 trasplantes realizados en el Hospital General Plaza de la Salud, evaluando cambios de calcio (Ca), fósforo (P) y hormona paratiroidea (PTH) antes y tres meses post-trasplante. Resultados: la edad media de los pacientes incluidos fue 43.1 ±13.1 años, 72.51 % pertenecía al sexo masculino, con un tiempo medio en hemodiálisis en meses de 27.0 ± 33.6, 60 % de los trasplantes realizados fueron de donante vivo y un 63 % de los pacientes tenía HTA como comorbilidad. El nivel medio de PTH disminuyó en los primeros 3 meses posteriores al trasplante comparado con el pre-trasplante (779.6 ± 1004.0 vs. 167.9 ± 138.2 pg/ml). El fosfato disminuyó significativamente (4.9 ± 1.6 vs. 3.5 ± 0.8) y el calcio aumentó (9.0 ± 1.2 mg/dl vs. a 9.7± 0.8 mg/dl). Discusión: los cambios generales en los niveles séricos de Ca, P, PTH, BUN y creatinina desde el momento del TR a los 3 meses post TR, fueron todos significativos

Introduction: Alterations of bone-mineral metabolism are an important cause of morbidity in patients with kidney transplantation, so the management of long-term transplant patient complications should be followed. The study tries to demonstrate changes in bone and mineral metabolism in patients with chronic renal disease undergoing kidney transplant in the Hospital General Plaza de la Salud during the period January 2010 to August 2018, Santo Domingo, Dominican Republic. Method: Observational, Descriptive, Retrospective and Cross-sectional Study of 131 transplants performed at Hospital General Plaza de la Salud, evaluating changes of calcium (Ca), phosphorus (P) and parathyroid hormone (PTH) before and 3 months post-transplant. Results: The mean age of the patients included was 43.1 ± 13.1 years, 72.51% belonged to the male sex, with a mean time on hemodialysis in months of 27.0 ± 33.6, 60% of the transplants performed were from live donors and 63% from the patients had hypertension as comorbidity. The mean PTH level decreased in the first 3 months after transplantation compared to the pre-transplant (779.6 ± 1004.0 vs 167.9 ± 138.2 pg/ml). Phosphate decreased significantly (4.9 ± 1.6 vs 3.5 ± 0.8) and calcium increased (9.0 ± 1.2 mg / dl vs. 9.7 ± 0.8 mg / dl). Discussion: The general changes in serum levels of Ca, P, PTH, BUN and Creatinine from the time of TR to 3 months post TR were all significant

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Objetivo: elaborar um modelo técnico-assistencial de enfermagem para pacientes de transplante renal. Método: desenvolvimento de modelo técnico-assistencial fundamentado nas teorias de Orem e Watson baseado na pesquisa convergente assistencial. O cenário foi um Centro Transplantador da região sul do Brasil. Coleta de dados - diagnóstico das atividades realizadas no serviço de transplante renal; entrevista semiestruturada com pacientes; e três grupos focais com enfermeiros. Participaram nove pacientes de transplante renal e dez enfermeiros que atuam nas fases do perioperatório. Utilizou-se análise de conteúdo. Resultados: categorias emergidas dos pacientes - expectativas do transplante renal; informação sobre o tratamento após transplante; mudança no estilo de vida após o adoecimento; importância do autocuidado; sentimentos envolvidos no transplante renal e melhorias do centro transplantador. Conclusão: o modelo desenvolvido foi fundamentado nas teorias de Watson e Orem contemplando integralidade, promoção do autocuidado e atuação do enfermeiro, bem como necessidades apontadas pelos pacientes.

Objective: to develop a model of nursing technical care for kidney transplant patients. Method: development of a technical care model based on the theories of Orem and Watson based on convergent care research. The setting was a Transplant Center in southern Brazil. Data collection - diagnosis of activities performed in the kidney transplant service; semi-structured interview with patients; and three focus groups with nurses. Nine kidney transplant patients and ten nurses who work in the perioperative period participated. Content analysis was performed. Results: categories emerged from patients - expectations of kidney transplantation; information about treatment after transplantation; lifestyle changes after illness; importance of self-care; feelings involved in kidney transplantation; and transplant center improvements. Conclusion: the developed model was based on Watson and Orem's theories and contemplated comprehensiveness, promotion of self-care and the role of nurses, as well as needs identified by patients.

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ABSTRACT Objective Lupus nephritis is one of the most severe complications of systemic lupus erythematosus and it has been estimated that can occur in up to 60% of patients. Direct costs of lupus nephritis have not been studied in developing countries. This study aimed to describe lupus nephritis direct costs in Colombia. Methods Administrative data from two Colombian health maintenance organizations for 2014 and 2015 was obtained. An algorithm based on the International Statistical Classification of Diseases and Related Health Problems 10th revision codes was developed to identify patients with lupus nephritis and lupus nephritis under study. Results The average annual per-patient, all-claims, all-cause direct cost for lupus nephritis was US$ 12,624, 7.5 times higher than the average lupus patient without lupus nephritis. For lupus nephritis cases under study, estimated direct cost was US$ 3,664, 2 times higher than average lupus patient in Colombia. Difference in lupus nephritis patients is mainly accounted for the cost and frequency of procedures, exceeding by a factor of 5 the cost for durable medical equipment and the cost for drugs, respectively. Conclusion Lupus patients who progress to lupus nephritis stage increased seven-fold the average annual per-patient, all-claims, and all-cause direct cost for the Colombian health system.

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Purpose: To investigate the protective effects of Shenkang injection (SKI) on adenine-induced chronic renal failure (CRF) in rat. Methods: Sprague Dawley rats were randomly divided into five groups: control, model, and SKI groups (5, 10, 20 mL/kg). Rats in model and SKI groups were treated with adenine i.g. at a dose of 150 mg/kg every day for 12 weeks to induce CRF. Twelve weeks later, SKI was administered to the rat i.p. for four weeks. The effects of SKI on kidney injury and fibrosis were detected. Results: SKI inhibited the elevation of the urine level of N-acetyl-b-D-glucosaminidase, kidney injury molecule-1, beta-2-microglobulin, urea protein in CRF rats. The serum levels of uric acid and serum creatinine increased and albumin decreased in the model group, which was prevented by SKI. SKI inhibited the release of inflammatory cytokines and increasing the activities of antioxidant enzymes in serum. SKI inhibited the expression of transforming growth factor-β1, vascular cell adhesion molecule 1, intercellular adhesion molecule 1, collagen I, collagen III, endothelin-1, laminin in kidney of CRF rats. Conclusions: SKI protected against adenine-induced kidney injury and fibrosis and exerted anti-inflammatory, and antioxidant effects in CRF rats.

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Objetivos: Detecção precoce de alterações cardíacas, em especial de preditores de fibrilação atrial (FA), em pacientes renais crônicos dialíticos, permitem condutas terapêuticas que podem impactar na morbimortalidade cardiovascular desses pacientes. Descrevemos alterações elétricas e estruturais cardíacas nos pacientes durante o 1º ano de hemodiálise (HD). Métodos: Estudo observacional, transversal, prospectivo, em pacientes entre 20 e 80 anos, renais crônicos, pertencentes a serviços públicos de São Paulo, divididos pelo tempo de início de hemodiálise: grupo 1: 1 a 6 meses; grupo 2: 7 a12 meses. Coletados dados sociodemográficos, mórbidos, eletrocardiograma de repouso, Holter 48h, ecocardiograma transtorácico e exames de sangue pré e pós hemodiálise ( função renal, eletrólitos, bicarbonato e inflamatórios). Analisados por teste T student e Qui-quadrado. Resultados: 73 pacientes, hipertensos, predomínio homens, quinquagenários, escolaridade fundamental, brancos, não solteiros, procedentes da região sudeste metropolitana, com multimorbidades e polifarmácia. Grupo 2 apresentou maior idade (p=0,007), morbidades (p=0,04), medicações (p=0,02), preditores de FA caracterizados por extrassístoles ventriculares ( p=0,02), aumento dos volumes e diâmetros ventriculares e átrio esquerdo (todos p≤0,001), alteração do bicarbonato pré e pós hemodiálise (p<0,01). Grupo 1 apresentou maiores alterações eletrolíticas pós hemodiálise (p≤0,03). Conclusão: Além da hipertensão arterial, tempo de hemodiálise, acidose metabólica próxima dos limites de referência, associaram-se precocemente à progressiva disfunção sisto-diastólica de câmaras esquerdas cardíacas e preditores de fibrilação atrial, em especial o volume sistólico final, predominantemente no 2º semestre do início de hemodiálise. Sugere-se Holter e Ecocardiograma a partir do 7º mês de hemodiálise e controles mais rígidos de acidose para essa população.

Objectives: Early detection of cardiac alterations in chronic renal patients on hemodyalisis (HD), especially atrial fibrillation (AF) predictors, allows therapeutic approaches that can impact their cardiovascular prognosis. We describe electrical and structural cardiac alterations in patients during the 1st year of hemodyalisis. Methods: Observational, cross-sectional, prospective study. Chronic kidney patients on dyalisis aged between 20 and 80 years, wihout atrial fibrillation, from public hemodyalisis services were divided by the time of hemodyalisis onset: group 1: 1 to 6 months; group 2: 7 to 12 months. Sociodemographic and morbid data, electrocardiogram at rest, Holter 48h, transthoracic echocardiogram and pre and post hemodialysis blood tests (kidney function, electrolytes and inflammatory tests) were collected. Data analyzed by Chi-square and Student T tests. Results: 73 hypertensive patients, predominantly men, aged in their fifties, elementary school, white, not single, from the metropolitan southeast region, with multimorbidities and polypharmacy were analyzed. Group 2 presented more age (p<0.01), morbidities (p=0.04), medications (p=0.02), atrial fibrillation, predictors especially ventricular extrasystoles (VES, p=0.02), increased left venticular and atrium volumes and diameters (all p≤0.001) and lower bicarbonate before and after hemodyalisis (both p≤0,01). Group 1 presented more changes in eletrolytes (p≤0.03). Conclusion: In addition to arterial hypertension, hemodyalisis duration was associated to systolic and diastolic dysfunction of the left cardiac chambers, atrial fibrillation predictors especially end-systolic volume (ESV) and mild acidosis, in the 2nd semestre predominantly. Holter and echocardiography are suggested from the 7th month of hemodyalisis onset and tighter metabolic control in this population

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O número de pessoas em diálise tem aumentado de maneira significativa nos últimos anos. Essas pessoas são, em geral, portadoras de condições crônicas múltiplas e complexas, e a coordenação do seu cuidado torna-se um desafio. O presente artigo objetiva sintetizar os resultados da literatura a respeito da coordenação do cuidado e dos cuidados primários ofertados ao paciente em diálise. Trata-se de uma revisão integrativa que teve como fontes de dados publicações disponíveis nas bases: LILACS, SciELO e PubMed. Foram identificados 16 artigos publicados entre 1992 e 2020. A partir da análise temática, evidenciaram-se cinco áreas: vínculo das pessoas em diálise com a Atenção Primária à Saúde (APS) e com o médico da família e comunidade (MFC); percepção dos profissionais quanto a seus papéis e habilidades; percepção das pessoas a respeito dos papéis e habilidades dos profissionais; cuidados primários (CP) prestados por nefrologistas e MFC; e impacto da APS na mortalidade, hospitalização e qualidade de vida. Os resultados sugerem que o nefrologista tem assumido o papel de coordenador do cuidado e de principal provedor de CP à pessoa em diálise. Todavia, isso não significa queos cuidados oferecidos sejam adequados às necessidades do paciente, devendo o MFC estar cada vez mais envolvido com esse cuidado, o que tem sido gradualmente observado nos últimos anos.

The number of patients on dialysis has increased significantly in recent years. These patients are, in general, carriers of multiple and complex chronic conditions, and the coordination of their care becomes a challenge. This article aims to summarize the results of the literature regarding the coordination of care for dialysis patients. This is an integrative review based on data published and available in the databases: LILACS, SciELO, and PubMed. 16 articles published between 1992 and 2020 were identified. Based on the thematic analysis, five areas were highlighted: linkage of patients with primary health care (PHC) and with the family and community physician (FCF); professionals' perception of their roles and skills; patients' perception of the professionals' roles and skills; primary care delivered by nephrologists and FCF; and the impact of PHC on mortality, hospitalization, and quality of life. The results suggest that nephrologists have assumed the role of care coordinators and main providers of primary care for dialysis patients. However, this does not mean that the care offered is adequate for the patient's needs, and the FCF should be increasingly involved with this care, which indeed began to gradually occur in recent years.

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BACKGROUND: Caregivers of patients with end-stage renal disease (ESRD) in dialysis endure a process of physical/emotional erosion derived from the implications of treatment and permanent care for prolonged periods of time. OBJECTIVE: To assess the quality of life (QoL) of primary caregivers of patients with ESRD in dialysis, and to identify predictors of low QoL. MATERIAL AND METHODS: Cross-sectional multicenter study. From May to September 2019, 137 caregivers and 174 patients, residents of Chihuahua city, were interviewed from four hospitals. Instruments used included: 1) questionnaire for sociodemographic/clinical data, 2) SF-36 and KD-SF to assess QoL of caregivers and patients with ESRD, respectively, 3) Zarit burden interview for caregivers, and 4) Goldberg anxiety/depression scale symptom inventory. RESULTS: Except for mental health, where mean QoL scores were similar between patients, caregivers, and non-caregivers, means were higher in caregivers and non-caregivers for all other domains. Caregivers showed lower summary scores compared with healthy non-caregivers in both physical and mental components. Caregiver's age, anxiety, time in dialysis, and patient's QoL were predictors of low QoL. CONCLUSIONS: Caregivers of patients in dialysis have better QoL compared with patients, but relatively similar to healthy individuals who do not take care of patients.

INTRODUCCIÓN: los cuidadores de pacientes con enfermedad renal crónica terminal (ERCT) en diálisis sufren un proceso de erosión física-emocional derivado de las implicaciones del tratamiento y del cuidado permanente por largos periodos de tiempo. OBJETIVO: evaluar la calidad de vida (CV) de cuidadores primarios de pacientes con ERCT en diálisis, e identificar predictores de baja CV. MATERIAL Y MÉTODOS: estudio multicéntrico transversal. De mayo a septiembre de 2019 se entrevistó a 137 cuidadores y 174 pacientes residentes de la ciudad de Chihuahua de cuatro hospitales. Los instrumentos empleados incluyeron: 1) un cuestionario para datos sociodemográficos/clínicos; 2) cuestionarios SF-36 y KD-SF para evaluar CV en cuidadores y pacientes con ERCT, respectivamente; 3) la escala de sobrecarga de Zarit para cuidadores, y 4) el inventario de síntomas para ansiedad y depresión de Goldberg. RESULTADOS: excepto para salud mental, donde las puntuaciones medias de CV fueron similares entre pacientes, cuidadores y no cuidadores sanos de referencia externa, las medias fueron mayores en cuidadores y no cuidadores para los demás dominios. Los cuidadores tuvieron menores medias para los componentes físico y mental, en comparación con los no cuidadores sanos. La edad del cuidador, la ansiedad, el tiempo en diálisis y la CV del paciente fueron predictores de baja CV. CONCLUSIONES: los cuidadores de pacientes en diálisis tienen mejor calidad de vida que los pacientes, y relativamente similar a la de individuos sanos que no cuidan pacientes.

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Abstract Introduction: National data on chronic dialysis treatment are essential for the development of health policies that aim to improve the treatment of patients. Objective: To present data from the Brazilian Dialysis Survey 2019, promoted by the Brazilian Society of Nephrology. Methods: Data collection from dialysis units in the country through a completed online questionnaire for 2019. Results: 314 (39%) centers responded the questionnaire. In July 2019, the estimated total number of patients on dialysis was 139,691. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 665 and 218, respectively, with mean annual increases of 25 pmp and 14 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 18.2%. Of the prevalent patients, 93.2% were on hemodialysis and 6.8% on peritoneal dialysis; and 33,015 (23.6%) on the waiting list for transplantation. 55% of THE centers offered treatment with peritoneal dialysis. Venous catheters were used as access in 24.8% of THE patients on hemodialysis. 17% of the patients had K ≥ 6.0mEq/L; 2.5% required red blood cell transfusion in July 2019 and 10.8% of the patients had serum levels of 25-OH vitamin D < 20 ng/mL. Conclusion: The absolute number of patients, the incidence and prevalence rates in dialysis in the country continue to increase, as well as the percentage of patients using venous catheter as dialysis access. There was an increase in the number of patients on the list for transplantation and a tendency to reduce gross mortality.

Resumo Introdução: Dados nacionais sobre o tratamento dialítico crônico são essenciais para a elaboração de políticas de saúde que almejem melhora no tratamento dos pacientes. Objetivo: Apresentar dados do Inquérito brasileiro de diálise de 2019, promovido pela Sociedade Brasileira de Nefrologia. Métodos: Coleta de dados das unidades de diálise do país através de questionário preenchido on-line referente a 2019. Resultados: 314 (39%) centros responderam ao questionário. Em julho de 2019, o número total estimado de pacientes em diálise foi de 139.691. As estimativas das taxas de prevalência e incidência de pacientes em tratamento dialítico por milhão da população (pmp) foram 665 e 218, respectivamente, com médias de aumento anuais de 25 pmp e 14 pmp para prevalência e incidência, respectivamente. A taxa anual de mortalidade bruta foi de 18,2%. Dos pacientes prevalentes, 93,2% estavam em hemodiálise e 6,8% em diálise peritoneal, e 33.015 (23,6%) em fila de espera para transplante. 55% dos centros ofereciam tratamento com diálise peritoneal. Cateter venoso era usado como acesso em 24,8% dos pacientes em hemodiálise. 17% dos pacientes tinham K ≥ 6,0mEq/L, 2,5% necessitaram de transfusão de hemácias em julho/2019 e 10,8% dos pacientes apresentavam níveis séricos de 25-OH vitamina D < 20 ng/mL. Conclusão: O número absoluto de pacientes e as taxas de incidência e prevalência em diálise no país continuam aumentando, assim como o percentual de pacientes em uso de cateter venoso como acesso para diálise. Houve aumento do número de pacientes na lista para transplante e tendência para redução da mortalidade bruta.

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RESUMEN Fundamento: la detección precoz de microalbuminuria en el paciente diabético es considerada como el mejor y más temprano marcador de nefropatía diabética. En la actualidad se le considera como un marcador de disfunción endotelial y enfermedad vascular. Objetivo determinar el comportamiento de la microalbuminuria en pacientes diabéticos pertenecientes al consultorio médico número 25 del Policlínico Comunitario Docente Presidente Salvador Allende de La Habana. Métodos: se realizó un estudio descriptivo de corte transversal. El universo lo constituyeron 1125 personas pertenecientes al consultorio médico. La muestra estuvo constituida por los 62 pacientes con diabetes mellitus. El estudio se realizó en el período de enero a diciembre del 2018. El diagnóstico de microalbuminuria se realizó después de comprobada en dos determinaciones de las tres realizadas en un período de 6 meses, quedando constituido dos grupos de pacientes según se determinó la presencia o no de microalbuminuria. Resultados: el 11,3 % de los pacientes diabéticos presentaron microalbuminuria. La presencia de microalbuminuria fue mayor en el sexo masculino (12,9 %), en los mayores o iguales a 70 años (21,4 %), en los diabéticos con tiempo de evolución de la enfermedad de 20 o más años (18,7 %), en los pacientes con diabetes mellitus insulino-dependiente (50 %) y en los pacientes con descontrol grave de la enfermedad (55,6 %). Conclusiones: la microalbuminuria predomina en los pacientes diabéticos de mayor edad, está relacionada con el tiempo de evolución de la diabetes mellitus. La microalbuminuria tiene relación con el control metabólico. Es más frecuente en los pacientes con diabetes mellitus insulino-dependiente.

ABSTRACT Background the early detection of microalbuminuria in diabetic patients is considered the best and earliest marker of diabetic nephropathy. It is currently considered as a marker of endothelial dysfunction and vascular disease. Objective to determine the behavior of microalbuminuria in diabetic patients belonging to the medical office 25 of the Presidente Salvador Allende Teaching Community Polyclinic in Havana. Methods a descriptive cross-sectional study was carried out. The universe was made up of 1125 people belonging to the medical office. The sample consisted of 62 patients with diabetes mellitus. The study was carried out from January to December 2018. The diagnosis of microalbuminuria was made after it was verified in two determinations of the three carried out in a period of 6 months, with two groups of patients being constituted according to whether the microalbuminuria presence or not was determined. Results the 11.3 % of the diabetic patients presented microalbuminuria. The presence of microalbuminuria was higher in males (12.9 %), in those older than or equal to 70 years old (21.4 %), in diabetics with a disease evolution time of 20 or more years (18, 7 %), in patients with insulin-dependent diabetes mellitus (50 %) and in patients with severe lack of control of the disease (55.6 %). Conclusions microalbuminuria predominates in older diabetic patients it is related to the diabetes mellitus evolution time. It is related to metabolic control. It is more common in patients with insulin-dependent diabetes mellitus.

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OBJECTIVE: To identify factors associated with chronic kidney disease of non-traditional causes among children in Guatemala. METHODS: A cross-sectional survey was conducted. The study population was all pediatric patients with stage 5 chronic kidney disease active in FUNDANIER's pediatric nephrology unit (N = 156). Simple random sampling led to a total of 100 participants. Data collection consisted of a questionnaire addressing individual and household characteristics, access and utilization of health care, and place of residence when the disease began. Chronic kidney disease etiology was obtained from medical records. Municipality-level secondary data were collected. Descriptive statistics were estimated. Logistic regression was used for bivariate and multivariate analysis. RESULTS: The odds ratio (OR) for almost all variables approached 1. Notable exceptions in household characteristics were mother's education level up to primary school (OR 2.2727) and living in an urban setting when symptoms began (OR 0.4035). Exceptions in municipal characteristics are zones with intensive small-scale agriculture (OR 3.8923) and those with intensive large-scale agriculture (OR 0.3338). P-values and confidence intervals show that the sample was not big enough to capture statistically significant associations between variables. CONCLUSIONS: Study findings suggest that factors associated with chronic kidney disease of non-traditional causes among children in Guatemala are intensive agricultural practices in their municipality of residence, and mother's level of education. Future research in children could use case-control designs or population-based studies in agricultural communities. Public health interventions that involve kidney function screening among children are recommended.

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ABSTRACT Introduction: Peritoneal dialysis (PD) has been considered a safe option of therapy in end-stage renal disease patients with urgent need of dialysis. Recently, it was proposed that Urgent-Start-PD (US-PD) be defined when PD starts within 72 hours after catheter placement and "early start" PD (ES-PD) when PD starts between 3 and 14 days after. We aimed to compare demographic and clinical characteristics between patients in US-PD and ES-PD as well as 30-day complications, 6-month hospitalization, and dropout rate. Methods: Adult patients starting PD within 14 days after catheter insertion (October/2016 - February/2019) were included and divided into US-PD group and ES-PD group based on the their PD initiation time. Clinical and demographic data, fill volume for the first PD session, 30-day complications, 6-month hospitalization, and dropout rate were assessed. Results: In our study, 72 patients were analyzed (US-PD=40, ES-PD=32) with mean age of 53.2±15.2 years old. No differences between US-PD and ES-PD regarding demographic characteristics, 30-day complications, 6-month hospitalization, and dropout events were found. The most frequent short-term complication in patients who started PD urgently was leakage. The most common cause of dropout was transfer to HD. Conclusion: Fifty five percent of our sample started PD less than 72 hours after catheter insertion. The lack of difference in the measured outcomes compared to patients that had therapy initiated after this period encourages the use of urgent PD when needed.

RESUMO Introdução: A diálise peritoneal (DP) tem sido considerada uma opção segura de terapia em pacientes com doença renal terminal com necessidade urgente de diálise. Recentemente, foi proposto que a DP de início urgente (US-PD) fosse definida quando a DP iniciar dentro de 72 horas após o implante do cateter, e a DP de "início precoce" (ES-PD) quando a DP iniciar entre 3 e 14 dias após o procedimento. Nosso objetivo foi comparar características demográficas e clínicas entre pacientes em US-PD e ES-PD, bem como complicações em 30 dias, internação por 6 meses e taxa de saída do tratamento. Métodos: Pacientes adultos iniciando DP em até 14 dias após a inserção do cateter (outubro/2016 - fevereiro/2019) foram incluídos e divididos no grupo US-PD ou ES-PD com base no tempo de início da DP. Dados clínicos e demográficos, volume de preenchimento na primeira sessão de DP, complicações em 30 dias, hospitalização por 6 meses e taxa de saída foram avaliados. Resultados: Em nosso estudo, 72 pacientes foram analisados (US-PD = 40, ES-PD = 32) com média de idade de 53,2 ± 15,2 anos. Não foram encontradas diferenças entre US-PD e ES-PD em relação às características demográficas, complicações em 30 dias, hospitalização por 6 meses e saída do tratamento. A complicação de curto prazo mais frequente nos pacientes que iniciaram a DP com urgência foi o extravasamento de líquido peritoneal. A causa mais comum de saída foi a transferência para HD. Conclusão: Mais da metade da nossa amostra iniciou a DP menos de 72 horas após a inserção do cateter. A falta de diferença nos desfechos mensurados em comparação com os pacientes que iniciaram o tratamento após esse período incentiva o uso de US-PD quando necessário.

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