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BACKGROUND: Uremic stomatitis is often unfamiliar to healthcare professionals. This study presents five cases of uremic stomatitis, providing a comprehensive analysis of their demographic distribution, clinicopathological features, and management strategies based on existing literature. METHODS: Data were collected from centers across Brazil, Argentina, Venezuela, and Mexico. Electronic searches were conducted in five databases supplemented by manual scrutiny and gray literature. RESULTS: The series consisted of three men and two women with a mean age of 40.2 years. Lesions mostly appeared as white plaques, particularly on the tongue (100%). The median blood urea level was 129 mg/dL. Histopathological analysis revealed epithelial changes, including acanthosis and parakeratosis, with ballooned keratinocytes in the suprabasal region. Oral lesions resolved subsequent to hemodialysis in three cases (75%). Thirty-seven studies comprising 52 cases of uremic stomatitis have been described hitherto. Most patients were male (65.4%) with a mean age of 43.6 years. Clinically, grayish-white plaques (37.3%) and ulcers/ulcerations (28.9%) were common, particularly on the tongue (30.9%). Hemodialysis was performed on 27 individuals. The resolution rate of oral lesions was 53.3%. CONCLUSION: Earlier recognition of uremic stomatitis, possibly associated with long-term uremia, holds the potential to improve outcomes for patients with undiagnosed chronic kidney disease.

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OBJECTIVE: To perform a systematic review with meta-analysis to assess recent scientific evidence on the association between periodontitis and systemic parameters/conditions in individuals with chronic kidney disease (CKD). MATERIALS AND METHODS: The search for studies was performed in MedLine/PubMed, Scopus, Web of Science, and BIREME databases. Reference lists of selected articles were also searched. Studies with different epidemiological designs evaluating the influence of exposure to periodontitis on serum markers and mortality in individuals with CKD were eligible for inclusion. Three independent reviewers performed the article selection and data extraction. The assessment of methodological quality used the adapted Newcastle Ottawa Scale. Random effects meta-analysis was performed to calculate association measurements and 95% confidence intervals. RESULTS: In total, 3053 records were identified in the database search, with only 25 studies meeting the eligibility criteria and, of these, 10 studies contributed data for meta-analysis. Using a random-effects model, periodontitis was associated with hypoalbuminemia (PRunadjusted = 2.47; 95%CI:1.43-4.26), with high levels of C-reactive protein (PRunadjusted = 1.35; 95%CI%:1.12-1.64), death from cardiovascular disease (RRunadjusted = 2.29; 95%CI:1.67-3.15) and death from all causes (RRunadjusted = 1.73; 95%CI:1.32-2.27). CONCLUSIONS: The findings of this review validated a positive association between periodontitis and serum markers and mortality data in individuals with CKD.

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OBJECTIVE: People living with chronic kidney disease (CKD) and receiving hemodialysis (HD) have impaired respiratory muscle strength and endurance. The objective of this study was to systematically review the effects of inspiratory muscle training (IMT) on respiratory muscle strength, functional capacity, lung function, quality of life, endothelial function, and oxidative stress in people living with CKD and receiving HD. METHODS: An electronic search was conducted from inception to June 2023. Randomized controlled trials that evaluated the effects of IMT on respiratory muscle strength, functional capacity, lung function, endothelial function, quality of life, or oxidative stress in adults living with CKD and receiving HD, compared with control, placebo IMT, or conventional physical therapy, were included. RESULTS: Eight studies were included, totaling 246 people. The meta-analysis showed that IMT increased the maximum inspiratory pressure (MIP) by 22.53 cm H2O, the maximum expiratory pressure (MEP) by 19.54 cm H2O, and the distance covered in the 6-minute walk test by 77.63 m. Changes in lung function and quality of life were not observed. It was not possible to quantitatively analyze data on endothelial function and oxidative stress. CONCLUSION: IMT improves MIP, MEP, and functional capacity in people living with CKD and receiving HD. IMT did not demonstrate significant results for lung function and quality of life. Effects on endothelial function and oxidative capacity remain uncertain. IMPACT: Inspiratory muscle training improves MIP, MEP, and functional capacity in people living with CKD and receiving HD, compared with conventional physical therapy or controls or placebo intervention. Increases in functional capacity in this population are extremely important because of the relationship with the survival of these people.

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Objective: To identify the adherence to therapeutic regimens in patients with chronic kidney disease undergoing hemodialysis (HD). Method: This is a descriptive, cross-sectional study using a quantitative approach developed at an HD center in the south of Minas Gerais, Brazil. The study participants were 51 patients undergoing HD. Personal, socioeconomic, and objective data were collected, and the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) was applied. The analysis was performed using simple descriptive statistics. Result: The average age was 56.7 years, and 58% of the patients were male. The percentages of non-adherence were diet (35.4%), hemodialysis (21.6%), fluid intake (15.7%), and medication (13.7%). Conclusion: Therapeutic adherence is a complex process that requires constant monitoring by a multidisciplinary team.

Objetivo: Identificar a adesão ao regime terapêutico de pacientes com doença renal crônica em hemodiálise. Método: Trata-se de um estudo descritivo, transversal, com abordagem quantitativa, desenvolvido em um centro de hemodiálise situado no sul de Minas Gerais. Os participantes do estudo foram 51 pacientes em tratamento hemodialítico. Foram coletados dados pessoais, socioeconômicos, objetivos aplicado o "Questionário de avaliação sobre a adesão do portador de doença renal crônica em hemodiálise". A análise foi realizada por meio de estatística descritiva simples. Resultado: A média de idade foi de 56,7 anos e 58% dos pacientes foram do sexo masculino. Os percentuais de não aderência encontrados foram dieta (35,4%), hemodiálise (21,6%), ingestão de líquidos (15,7%) e medicação (13,7%). Conclusão: A adesão terapêutica é um processo complexo, e por isso necessita de acompanhamento constante pela equipe multiprofissional.

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OBJECTIVES: To externally validate the four-variable kidney failure risk equation (KFRE) in the Peruvian population for predicting kidney failure at 2 and 5 years. DESIGN: A retrospective cohort study. SETTING: 17 primary care centres from the Health's Social Security of Peru. PARTICIPANTS: Patients older than 18 years, diagnosed with chronic kidney disease stage 3a-3b-4 and 3b-4, between January 2013 and December 2017. Patients were followed until they developed kidney failure, died, were lost, or ended the study (31 December 2019), whichever came first. PRIMARY AND SECONDARY OUTCOME MEASURES: Performance of the KFRE model was assessed based on discrimination and calibration measures considering the competing risk of death. RESULTS: We included 7519 patients in stages 3a-4 and 2798 patients in stages 3b-4. The estimated cumulative incidence of kidney failure, accounting for competing event of death, at 2 years and 5 years, was 1.52% and 3.37% in stages 3a-4 and 3.15% and 6.86% in stages 3b-4. KFRE discrimination at 2 and 5 years was high, with time-dependent area under the curve and C-index >0.8 for all populations. Regarding calibration in-the-large, the observed to expected ratio and the calibration intercept indicated that KFRE underestimates the overall risk at 2 years and overestimates it at 5 years in all populations. CONCLUSIONS: The four-variable KFRE models have good discrimination but poor calibration in the Peruvian population. The model underestimates the risk of kidney failure in the short term and overestimates it in the long term. Further research should focus on updating or recalibrating the KFRE model to better predict kidney failure in the Peruvian context before recommending its use in clinical practice.

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Resumo Objetivo Avaliar e comparar as fórmulas CKD-EPI, BIS1 e MDRD e o limiar diagnóstico de 45 e 60 ml/min/1,73m2 em pacientes idosos. Método Estudo observacional do tipo transversal, de caráter descritivo e analítico. Foram incluídos pacientes atendidos em ambulatório de referência entre janeiro/2020 e junho/2022, com idade ≥65 anos. Foram excluídos pacientes com apenas uma dosagem de creatinina ou com alterações transitórias da TFG. Resultados Observou-se que entre o grupo de pacientes com idade entre 65-74 anos e 75-84 anos as estimativas da TFG feitas pela fórmula CKD-EPI foram superiores às fórmulas BIS1 e MDRD. Enquanto, no grupo de pacientes com 85-94 anos a CKD-EPI não apresentou diferença quando comparada com MDRD, permaneceu com estimativas maiores apenas quando comparada com a BIS1. Observamos maior dispersão entre CKD-EPI e BIS1, mostrando menor concordância entre essas fórmulas, confirmada pelo teste Kappa (76,7%) e a concordância quase perfeita entre CKD-EPI e MDRD. Conclusão A fórmula BIS1 apresentou melhor correlação da diminuição da TFGe conforme o avanço das faixas etárias, podendo-se relacionar com o processo de envelhecimento renal fisiológico, podendo ser uma ferramenta auxiliar na estimativa da TFG em idosos, auxiliando no diagnóstico mais preciso da DRC, assim como, no planejamento de intervenções que possam retardar a progressão da DRC e prever risco de mortalidade por doenças cardiovasculares.

Abstract Objective To evaluate and compare the CKD-EPI, BIS1 and MDRD formulas and diagnostic thresholds of 45 and 60 ml/min/1.73m2 in older patients. Method A cross-sectional, descriptive, analytical observational study was conducted. Patients aged ≥65 years treated at a referral outpatient clinic between January 2020 and June 2022, were assessed. Patients with only one creatinine level or with transient GFR abnormalities were excluded. Results The GFR estimates using the CKD-EPI formula were higher than both the BIS1 and MDRD formulas in patient groups aged 65-74 years and 75-84 years. In the group of patients aged 85-94 years, the CKD-EPI showed no difference when compared with the MDRD, yielding higher estimates only compared with the BIS1. Greater dispersion was found between the CKD-EPI and BIS1, showing less agreement between these formulas, as confirmed by the Kappa test (76.7%), while there was almost perfect agreement between the CKD-EPI and MDRD. Conclusion The BIS1 formula showed stronger correlation of the decrease in eGFR with advancing age, reflecting the physiological renal aging process and serving as a potentially useful tool for estimating GFR in older adults. The formula can help provide a more accurate diagnosis of CKD and aid planning of interventions to slow the progression of CKD and predict the risk of mortality from cardiovascular diseases.

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Contexto: la investigación busca determinar la relación entre la inteligencia emocional y la calidad de vida en pacientes con insuficiencia renal crónica que reciben tratamiento de hemodiálisis de un hospital de la ciudad del Cusco, considerando el riesgo de la enfermedad para el logro de una mejor vida y los recursos existentes en la psicología de la salud. Metodología: el estudio se ubica en un nivel básico con un alcance correlacional y un diseño no experimental-transversal. Se incluyeron 96 pacientes diagnosticados con insuficiencia renal crónica que asistían a hemodiálisis y que fueron evaluados con el inventario emocional BarOn y el cuestionario KDQOL SF-36 para la calidad de vida. Los datos de identificación de los pacientes fueron obtenidos de las fichas de registro utilizadas, previo consentimiento informado de los evaluados. Posteriormente, para el análisis de datos descriptivos e inferenciales, se emplearon frecuencias y porcentajes; además de estadísticos de asociación, como el tau-b de Kendall, chi cuadrado y d de Somers. Resultados: la relación para inteligencia emocional y calidad de vida muestra un valor de p < 0,05, mediante la prueba de chi cuadrado; el estadístico tau-b de Kendall = 0,340 explica la dirección positiva de la relación e intensidad moderada de la asociación; el estadístico d de Somers = 0,339 ratifica que la inteligencia emocional en general mejora la calidad de vida de los pacientes en una intensidad media. También, se halló una relación significativa para cada una de las dimensiones de la inteligencia emocional con la calidad de vida. Conclusiones: existe relación directa entre inteligencia emocional y calidad de vida en pacientes con insuficiencia renal crónica en hemodiálisis.

Background: The research seeks to determine the relationship between emotional intelligence and quality of life in patients with chronic renal failure who receive hemodialysis treatment at a hospital in the city of Cusco, considering the risk of the disease for achieving a better life and the existing resources in health psychology. Methods: The study is located at a basic level, following a correlational scope and a non-experimental - cross-sectional design. 96 patients diagnosed with chronic renal failure attending hemodialysis were included, who were evaluated with the BarOn Emotional Inventory and the KDQOL SF-36 questionnaire for quality of life. The identification data of the patients were obtained from the registration forms used, with the prior informed consent of those evaluated. Subsequently, for the analysis of descriptive and inferential data, frequencies and percentages were used, in addition to association statistics such as Kendall's Tau-b, Chi square and Somers' D. Results: The relationship for emotional intelligence and quality of life shows a value of p < 0.05, using the Chi-square test, the Kendall Tau-b statistic = 0.340, explains the positive direction of the relationship and moderate intensity of the association. , Somers' D statistic=0.339 confirms that emotional intelligence in general improves the quality of life of patients at a medium intensity. A significant relationship was also found for each of the dimensions of emotional intelligence with quality of life. Conclusions: There is a direct relationship between emotional intelligence and quality of life in patients with chronic renal failure on hemodialysis.

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Introducción: La hipopotasemia es un trastorno hidroelectrolítico frecuente, asociado a enfermedades sistémicas y multifactoriales, cuya forma aguda puede complicarse y causar la muerte, pero en su presentación crónica puede ser un marcador de nefropatía. Objetivo: Caracterizar el perfil del paciente con hipopotasemia no medicamentosa atendidos de emergencia. Métodos: Se revisaron los registros de pacientes mayores de 18 años con diagnóstico de hipopotasemia, ingresados en el hospital en el período de junio 2018 a diciembre de 2019. Se colectaron datos demográficos, antecedentes médicos y evolución postratamiento. Se comparó con 108 pacientes sin hipopotasemia atendidos en el período de estudio. Resultados: Se encontraron 87 casos con edad media de 38,5 años. El 90,8 por ciento eran hombres menores de 50 años, de oficio agricultor (29,9 por ciento), con historia de exposición a plaguicidas y a altas temperaturas ambientales. La mayoría de ellos no tenía historia de enfermedad cardiometabólicas o renal previa. El 48,3 por ciento de todos los pacientes con hipopotasemia (n = 42) tenía creatinina mayor a 1,2 mg/dL y 63 por ciento tenía hiponatremia. La hipopotasemia fue moderada en 39 por ciento y severa en 12 por ciento, los hombres 4,7 veces más afectados que las mujeres. Respecto al grupo sin hipopotasemia y creatinina anormal, tenían mayor frecuencia de enfermedad crónica (92,5 por ciento versus 8 por ciento). Conclusiones: Se encontró hipopotasemia no medicamentosa en varones agricultores, sin enfermedad crónica, pero con datos de nefropatía temprana e hiponatremia, se sugirió la posibilidad de nefropatía mesoamericana. Debe establecerse una alerta epidemiológica regional y un programa de prevención y control(AU)

Introduction: Hypokalemia is a frequent hydroelectrolytic disorder, associated with systemic and multifactorial diseases, whose acute form can be complicated and cause death, but in its chronic presentation it can be a marker of nephropathy. Objective: To characterize the profile of the patient with non-drug hypokalemia seen in an emergency. Methods: The records of patients older than 18 years diagnosed with hypokalemia, admitted to the hospital from June 2018 to December 2019, were reviewed. Demographic data, medical history, and post-treatment evolution were collected. It was compared with 108 patients without hypokalemia seen in the same period. Results: 87 cases with mean age of 38.5 years were studied. 90.8% were men under 50 years of age, who worked as farmers (29.9percent), with history of exposure to pesticides and high ambient temperatures. Most of them had no history of previous cardiometabolic or renal disease. 48.3percent of all patients with hypokalemia (n = 42) had creatinine higher than 1.2 mg/dL and 63percent had hyponatremia. Hypokalemia was moderate in 39% and severe in 12percent, and it was found that men were affected 4.7 times more than women. Regarding the group without hypokalemia and abnormal creatinine, they had higher frequency of chronic disease (92.5percent versus 8percent). Conclusions: Non-drug hypokalemia was found in male farmers, without chronic disease, but with evidence of early nephropathy and hyponatremia. The possibility of Mesoamerican nephropathy was suggested. A regional epidemiological alert and a prevention and control program should be established(AU)

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ABSTRACT Introduction: Fabry disease (FD) is an inborn error of metabolism characterized by α-galactosidase A deficiency. The primary objective was to evaluate the genetic and phenotypic profile of Fabry disease in hemodialysis. Methods: Observational cohort study to determine the incidence of genetic variations and phenotypic changes for FD in hemodialysis patients in the Paraiba Valley and Eastern São Paulo. Genetic testing for the GLA gene was performed for men and women over 12 years of age at the hemodialysis clinics between January 2016 and December 2019 as a screening protocol. Results: The cases came from screening exams of the index case among patients with chronic kidney disease, resulting in 17 families and totaling 82 patients under study. The classification of the most prevalent variant was that of uncertain significance (54%), followed by the pathogenic variant (46%). Five patients in two families were described with two types of variants not previously described in the literature, with pathogenic behavior. Comparing the types of variants, the presence of a pathogenic variant was associated with higher levels of lysoGB3, lower values for alpha-GAL activity and higher frequency of symptoms related to FD. Conclusion: We characterized an extensive population of patients with FD variants with rich genetic, clinical and biomarker details. We believe that this study can help to better characterize the Brazilian population with FD and the most frequent types of variants.

RESUMO Introdução: A doença de Fabry (DF) é um erro inato do metabolismo caracterizado pela deficiência da enzima α-galactosidase A. O objetivo primário foi avaliar o perfil genético e fenotípico da doença de Fabry em hemodiálise. Métodos: Estudo de coorte observacional para determinar a incidência de variações genéticas e alterações fenotípicas para DF em pacientes em hemodiálise no Vale do Paraíba e Zona Leste de São Paulo. O teste genético para o gene GLA foi realizado para homens e mulheres em todos os pacientes das clínicas de hemodiálise maiores de 12 anos entre janeiro de 2016 a dezembro de 2019 como protocolo de rastreio. Resultados: Os casos foram provenientes de exames de triagem do caso índice entre pacientes portadores de doença renal crônica, resultando em 17 famílias e totalizando 82 pacientes em estudo. A classificação da variante mais prevalente foi a de significado incerto (54%), seguida da variante patogênica (46%). Foram descritos 5 pacientes em duas famílias com dois tipos de variantes ainda não previamente descritos na literatura com comportamento patogênico. Na comparação entre os tipos de variantes, a presença de variante patogênica foi associada a maiores níveis de lysoGB3, menores valores da atividade da alfa-GAL e maior frequência de sintomas relativos à DF. Conclusão: Caracterizamos uma extensa população de pacientes com variantes para DF com riqueza de detalhes de genética, clínica e de biomarcadores. Acreditamos que este estudo possa auxiliar na melhor caracterização da população brasileira com DF e nos tipos mais frequentes de variantes.

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Introducción: La enfermedad renal crónica es una de las principales causas de mortalidad en todo el mundo. La estratificación del riesgo a través del análisis de factores pronósticos podría generar un cambio de paradigma. Objetivo: Analizar los factores pronósticos de mortalidad en los pacientes con enfermedad renal crónica en hemodiálisis. Métodos: Se realizó un estudio no experimental, longitudinal de cohorte retrospectivo en los pacientes con enfermedad renal crónica en hemodiálisis en el Hospital General Docente: Dr. Ernesto Guevara de la Serna durante el período del 1 de enero de 2017 al 31 de diciembre de 2021. En general, se analizaron los factores pronósticos de mortalidad mediante el análisis multivariado de regresión logística binaria y se determinó el porcentaje correcto de clasificación del modelo de regresión. Resultados: Se analizaron como variables pronosticas de mortalidad la enfermedad cardiovascular [B = 3,831; p = 0,000; Exp (B) = 46,118], Albúmina 17 mmol/L [B = 1,326; p = 0,027; Exp (B) = 3,767], glucemia < 4 mmol/L [B = 1,600; p = 0,015; Exp (B) = 4,955] y ganancia de peso interdialítica excesiva [B = 2,243; p = 0,001; Exp (B) = 9,420]. El porcentaje global de clasificación del modelo de regresión logística binaria fue de 89,5 por ciento. Conclusiones: Se analizó el modelo predictivo de regresión logística que presentó una buena precisión con los factores de pronósticos asociados a la mortalidad en los pacientes en hemodiálisis(AU)

Introduction: Chronic kidney disease is one of the main causes of mortality worldwide. Risk stratification through the analysis of prognostic factors could generate a paradigm shift. Objective: To analyze the prognostic factors of mortality in patients with chronic kidney disease on hemodialysis. Methods: A non-experimental, longitudinal retrospective cohort study was carried out on patients with chronic kidney disease on hemodialysis at Dr. Ernesto Guevara de la Serna General Teaching Hospital from January 2017 to December 31, 2021. The prognostic factors of mortality were analyzed using multivariate binary logistic regression analysis and the correct percentage of classification of the regression model was determined. Results: Prognostic variables of mortality were analyzed, such as cardiovascular disease [B = 3.831; p = 0.000; Exp (B) = 46.118], albumin 17 mmol/L [B = 1.326; p = 0.027; Exp (B) = 3.767], blood glucose < 4 mmol/L [B = 1.600; p = 0.015; Exp (B) = 4.955] and excessive interdialytic weight gain [B = 2.243; p = 0.001; Exp(B) = 9.420]. The overall classification percentage of the binary logistic regression model was 89.5percent. Conclusions: The logistic regression predictive model was analyzed, which showed good precision with the prognostic factors associated with mortality in hemodialysis patients(AU)

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Introduction: Liver cirrhosis is the fourth cause of death in the world. Fatty liver disease is the most common cause of chronic liver disease (CKD) in most countries. Identifying risk factors for liver fibrosis in a population with end-stage renal disease (ESRD) may facilitate early diagnosis of this complication and allow the activation of follow-up protocols to reduce morbidity and mortality in these patients. Materials and methods: A cross-sectional and analytical study was carried out. Patients on hemodialysis, older than 18 years with a diagnosis of diabetes mellitus and ESRD were included. The hypotheses were contrasted through the chi-square test and Student's T-test, as appropriate. Statistical significance was established at a p-value = 0.05. Results: A prevalence of significant liver fibrosis and cirrhosis of 17% was found. Factors associated with liver fibrosis were a history of cerebrovascular disease, peripheral vascular disease, body mass index (BMI), total cholesterol, glycosylated hemoglobin, sodium, and aspartate aminotransferase (AST). No relationship was observed between the NAFLD (non-alcoholic fatty liver disease) score, the APRI index (AST to Platelet Ratio Index), and fibrosis. Conclusion: The prevalence of significant liver fibrosis in patients with diabetes and ESRD is similar to that reported in other populations of patients with diabetes. However, some factors, such as BMI, could behave differently and favor the appearance of liver injury with lower degrees of obesity than previously reported in the literature.

Introducción: la cirrosis hepática es la cuarta causa de muerte en el mundo. Actualmente, la enfermedad hepática por depósito de grasa es la causa más frecuente de hepatopatía crónica en la mayoría de los países. La identificación de factores de riesgo para la presencia de fibrosis hepática en una población con enfermedad renal crónica terminal puede facilitar el diagnóstico temprano de esta complicación y permitir la activación de protocolos de seguimiento para disminuir la morbimortalidad en estos pacientes. Metodología: se realizó un estudio de corte transversal y analítico. Se incluyeron pacientes en hemodiálisis, mayores de 18 años con diagnóstico de diabetes mellitus y de enfermedad renal crónica terminal. El contraste de hipótesis se realizó a través de la prueba de chi cuadrado y la T de Student, según correspondiera. La significación estadística se estableció con un valor p = 0,05. Resultados: se observó una prevalencia de fibrosis hepática significativa y cirrosis del 17%. Los factores asociados a la presencia de fibrosis hepática fueron los antecedentes de enfermedad cerebrovascular, la enfermedad vascular periférica, el índice de masa corporal (IMC), el colesterol total, la hemoglobina glicosilada, el sodio y el aspartato-aminotransferasa (AST). No se observó relación entre el puntaje de NAFLD (enfermedad del hígado graso no alcohólico), el índice APRI (AST to Platelet Ratio Index) y la presencia de fibrosis. Conclusión: la prevalencia de fibrosis hepática significativa en pacientes con diabetes y ERCT es similar a la reportada en otras poblaciones de pacientes con diabetes. Sin embargo, algunos factores, como el IMC, podrían comportarse de forma diferente y favorecer la aparición de lesión hepática con grados menores de obesidad a los reportados previamente en la literatura.

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Chronic kidney disease (CKD) has become a public health concern over the last several years. Nowadays developed countries spend around 3% of their annual health-care budget on patients with CKD. According to the scientific community the most remarkable risk factors for CKD are diabetes and hypertension. Unknown CKD etiology has been reported as a global phenomenon including uncommon risk factors such as: dehydration, leptospirosis, heat stress, water quality, and others. This study aims to report non-traditional risk factors for ESRD based on a scoping review methodology. The scoping review methodology described by Arksey and O'Malley was used by performing an extensive review of the information. A total of 46 manuscripts were reviewed. The non-traditional ESRD risk factors are depicted based on six categories. Gender and ethnicity have been considered as risk factors for ESRD. Erythematous systemic lupus (ESL) is reported as an important risk factor for ESRD. Pesticide use has been an significant risk factor due to its effects on human and environmental health. Some compounds commonly used in homes against insects and plants are related to ESRD. Congenital and hereditary diseases in the urinary tract have been studied as a cause of ESRD in children and young adults. End-stage renal disease is a major concern for public health on a global level. As it can be seen, non-traditional risk factors are several and have different etiologies. It is necessary to put the issue on the table and add it to the public agenda in order to find multidisciplinary solutions.

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Contexto: la glomerulonefritis aguda posinfecciosa (GNPI) representa un riesgo para el desarrollo de insuficiencia renal a largo plazo. Objetivo: describir la incidencia de proteinuria persistente y factores asociados en pacientes con antecedente de GNPI en una cohorte pediátrica de un hospital de referencia en Paraguay. Metodología: se incluyó a 121 pacientes con síndrome nefrítico con C3 disminuido, con normalización a los tres meses, aunque no se haya comprobado etiología estreptocócica. Se excluyó a los pacientes con enfermedad renal previa, con síndrome nefrítico secundario y con menos de seis meses de seguimiento. Se analizaron las características sociodemográficas, infecciones precedentes, aclaramiento de creatinina, días de hipertensión arterial y de internación, además de la relación de estas con la persistencia de proteinuria a los seis meses y más de seguimiento. Resultados: de los 121 pacientes entre 2 a 16 años de edad incluidos, 75 pacientes tuvieron un seguimiento médico entre 6 y 48 meses, de los cuales 43 (57,3 %) desarrollaron proteinuria persistente, la cual se asoció con un menor aclaramiento de creatinina (p = 0,03; 67,74 ± 25,69 mL/min/1,73 m2 SC vs. 80,22 ± 2,98 mL/min/1,73 m2 SC), con el número promedio de convivientes (6,3 ± 2,8 vs. 5,3 ± 2,3; p = 0,027) y el número promedio de hijos (4,3 ± 2,7 vs. 3,6 ± 2,3; p = 0,048). No se encontró asociación con las otras características. Conclusiones: la incidencia de proteinuria se asoció con un menor aclaramiento de creatinina y con una mayor frecuencia de los determinantes sociales en salud.

Background: Acute post-infectious glomerulonephritis (PIGN) represents a risk for the development of long-term renal failure. Purpose: To describe the incidence of proteinuria in patients with a history of PIGN in a pediatric cohort at a referral hospital in Paraguay. Methodology: a total of 121 patients with nephritic syndrome with decreased C3 and normalization at 3 months, although streptococcal aetiology has not been proven were included. Patients with with previous kidney disease, with secondary nephritic syndrome and with less than 6 months of follow up were excluded. Sociodemographic characteristics, previous infection, creatinine clearance, days of arterial hypertension and hospitalization were analyzed, in addition to their relationship with the persistence of proteinuria at 6 months and more of follow-up. Results: Of the 121 patients between 2 and 16 years of age included, 75 patients had a medical follow-up between 6 and 48 months, 43 (57.3 %) of them developed persistent proteinuria, which was associated with lower creatinine clearance (p = 0.03; 67.74 ± 25.69 mL/min/1.73 m2 BM vs 80.22 ± 2.98 mL/min/1.73 m2 BM), higher average number of cohabitants (6.3 ±2.8 vs 5.3±2.3; p= 0.027) and higher average number of children (4.3±2.7 vs 3.6±2.3; p= 0.048). No association was found with other characteristics. Conclusions: the incidence of proteinuria in this series was associated with lower creatinine clearance and a higher frequency of social determinants in health.

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Detrusor hypoactivity (DH) is characterized by low detrusor pressure or a short contraction associated with low urinary flow. This condition can progress to chronic renal failure (CRF) and result in the need for dialysis. The present case report demonstrates that a patient diagnosed with DH and CRF who received two transplants with 2 × 106 autologous mesenchymal stromal cells at an interval of 30 days recovered the contractile strength of the bladder and normalized his renal function. The patient had a score of 19 on the ICIQ-SF before cell therapy, and that score was reduced to 1 after transplantation. These results demonstrate that there was an improvement in his voiding function, urinary stream and urine volume as evaluated by urofluxometry. In addition, a urodynamic study carried out after treatment showed an increase in the maximum flow from 2 mL/s to 23 mL/s, the detrusor pressure in the maximum flow from 21 cm H2O to 46 cm H2O and a BCI that went from 31 to 161, characterizing good detrusor contraction. Thus, in the present case, the transplantation of autologous mesenchymal stromal cells proved to be a viable therapeutic option to allow the patient to recover the contractile strength of the bladder, and reversed the CRF.

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A periodontite é uma doença infecto-inflamatória associada ao biofilme disbiótico que afeta os tecidos de proteção e de suporte dos dentes. O processo inflamatório que ocorre durante a periodontite tem sido associado à inflamação sistêmica em pacientes com doença renal crônica. Os polimorfismos genéticos são alterações no DNA que podem ter classificações diferentes dependendo da mutação gerada, e podem ser criados ou destruídos. Objetivo: O objetivo desta revisão sistemática da literatura foi elucidar a seguinte questão: os polimorfismos genéticos estão associados à doença renal crônica e à periodontite? Material e Métodos: A pesquisa foi realizada no PubMed, Biblioteca Cochrane, EMBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Bibliografia Brasileira de Odontologia (BBO), Biblioteca Virtual em Saúde (BVS), SciELO, Scopus, Web of Science e bases de dados de literatura cinzenta (Google Scholar) sem restrições de data ou idioma em 28 de junho de 2021 e atualizada em 26 de janeiro de 2023. Os descritores padronizados (Medical Subject Headings, MeSH) utilizados foram: "polimorfismo genético", "doença renal crônica" e "periodontite", de acordo com o banco de dados consultado, utilizando os operadores booleanos "AND". Resultado: 25 publicações foram identificadas. Após a análise do título, do resumo e do texto completo, 6 estudos de caso-controle foram selecionados para análise. Todos incluíam artigos investigando o papel de diferentes polimorfismos genéticos em ambas as doenças. Alguns genes apresentavam uma relação próxima com o perfil inflamatório que caracteriza ambas as doenças. Conclusão: Entre os polimorfismos estudados, os polimorfismos VNTR no gene IL4 e MCP-1-2518 A/G apresentaram uma associação positiva tanto com a periodontite quanto com a doença renal crônica. Entretanto, são necessários mais estudos para melhor compreensão do papel dos polimorfismos genéticos nessas doenças.

Periodontitis is an infectious-inflammatory disease associated with dysbiotic biofilm that affects the protective and supporting tissues of the teeth. The inflammatory process that occurs during periodontitis has been associated with systemic inflammation in patients with chronic kidney disease. Genetic polymorphisms are changes in DNA that can have different classifications depending on the mutation generated, and can be created or destroyed. Objective: The aim of this systematic review of the literature was to elucidate the following question: are genetic polymorphisms associated with chronic kidney disease and periodontitis? Material and Methods: The search was conducted in PubMed, Cochrane Library, EMBASE, Latin American and Caribbean Literature on Health Sciences (LILACS), Brazilian Bibliography of Dentistry (BBO), Virtual Health Library (VHL), SciELO, Scopus, Web of Science and gray literature databases (Google Scholar) without date or language restrictions on June 28, 2021 and updated on January 26, 2023. The standardized descriptors (Medical Subject Headings, MeSH) used were: "genetic polymorphism", "chronic kidney disease" and "periodontitis", according to the database consulted, using the Boolean operators "AND". Result: 25 publications were identified. After reviewing the title, abstract, and full text, 6 case-control studies were selected for analysis. All included articles investigating the role of different genetic polymorphisms in both diseases. Some genes showed a close relationship with the inflammatory profile that characterizes both diseases. Conclusion: Among the polymorphisms studied, the VNTR polymorphisms in the IL4 gene and MCP- 1-2518 A/G showed a positive association with both periodontitis and chronic kidney disease. However, further studies are needed to better understand the role of genetic polymorphisms in these diseases.

La periodontitis es una enfermedad infeccioso-inflamatoria asociada a un biofilm disbiótico que afecta a los tejidos protectores y de soporte de los dientes. El proceso inflamatorio que se produce durante la periodontitis se ha asociado con la inflamación sistémica en pacientes con enfermedad renal crónica. Los polimorfismos genéticos son cambios en el ADN que pueden tener diferentes clasificaciones dependiendo de la mutación generada, pudiendo ser creados o destruidos. Objetivo: El objetivo de esta revisión sistemática de la literatura fue dilucidar la siguiente pregunta: ¿están asociados los polimorfismos genéticos con la enfermedad renal crónica y la periodontitis? Material y Métodos: La búsqueda fue realizada en PubMed, Cochrane Library, EMBASE, Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Bibliografía Brasileña de Odontología (BBO), Biblioteca Virtual en Salud (BVS), SciELO, Scopus, Web of Science y bases de datos de literatura gris (Google Scholar) sin restricciones de fecha o idioma el 28 de junio de 2021 y actualizada el 26 de enero de 2023. Los descriptores normalizados (Medical Subject Headings, MeSH) utilizados fueron: "polimorfismo genético", "enfermedad renal crónica" y "periodontitis", según la base de datos consultada, utilizando los operadores booleanos "AND". Resultado: Se identificaron 25 publicaciones. Tras analizar el título, el resumen y el texto completo, se seleccionaron 6 estudios de casos y controles para su análisis. Todos los trabajos incluidos investigaban el papel de diferentes polimorfismos genéticos en ambas enfermedades. Algunos genes mostraron una estrecha relación con el perfil inflamatorio que caracteriza a ambas enfermedades. Conclusión: Entre los polimorfismos estudiados, los polimorfismos VNTR en el gen IL4 y MCP-1-2518 A/G mostraron una asociación positiva tanto con la periodontitis como con la enfermedad renal crónica. Sin embargo, se necesitan más estudios para comprender mejor el papel de los polimorfismos genéticos en estas enfermedades.

RESUMO

The objective of this study was to evaluate whether individuals with chronic renal failure (CRF) undergoing hemodialysis treatment have more salivary and oral mucosa alterations when compared to healthy individuals, through a systematic review followed by meta-analysis. A systematic literature review was performed, evaluating randomized clinical trials found in the Proquest, Embase, Scopus, Cochrane Library, Web of Science, Lilacs and Pubmed databases, using MeSH terms and other keywords. Initially, 40 articles were included in the study and, after reading the complete articles, only 15 clinical trials that analyzed oral lesions and salivary changes in patients with CRF undergoing hemodialysis treatment were eligible. Most of the clinical studies included were cross-sectional and composed of a study group and a control group. The mean age of participants in the study group was 50.19 years and in the control group, 48.95 years. The most common oral alterations found in the CRF group in relation to the control group were xerostomia, uremic breath, dysgeusia, coated tongue, gingival bleeding and pale mucosa. The salivary flow of patients with CRF was 46.6% lower than the control group. The salivary pH in the study group was also more alkaline when compared to the control group. Greater amounts of urea, phosphate, C-reactive protein and total proteins were found in the saliva of individuals with CRF. Individuals with CRF undergoing hemodialysis are more prone to changes in both the quantity and quality of saliva, as well as having a greater amount of oral changes.

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RESUMO

ABSTRACT Objective: to analyze the metric properties of the Instrumento de Evaluación de la Experiencia del Paciente Crónico version adapted to Brazilian Portuguese. Method: this is a methodological and cross-sectional study conducted with 132 patients with chronic kidney disease on hemodialysis. Cronbach's alpha was used in the reliability assessment. Construct validity was assessed by means of Exploratory Factor Analysis and Confirmatory Factor Analysis. Results: the Instrumento de Evaluación de la Experiencia del Paciente Crónico tool obtained an overall Cronbach's alpha of 0.75. Unidimensionality of the instrument was recommended in the Exploratory Factor Analysis and confirmed through Confirmatory Factor Analysis, with the indices indicating good fits according to the established criteria. The results indicated the following values: χ2/g = 1.129; Goodness-of-Fit Index = 0.96; Root-Mean-Square Error of Approximation = 0.050; Tucker-Lewis Index = 0.97 and Adjusted Goodness-of-Fit Index = 0.94. Conclusion: the Instrumento de Evaluación de la Experiencia del Paciente Crónico tool shows diverse evidence of satisfactory reliability and validity in patients with chronic kidney disease undergoing hemodialysis.

RESUMEN Objetivo: analizar las propiedades métricas de la versión del Instrumento de Evaluación de la Experiencia del Paciente Crónico adaptada al portugués de Brasil. Método: estudio metodológico y transversal realizado con 132 pacientes que padecen enfermedad renal crónica sometidos a hemodiálisis. Para evaluar la confiabilidad se utilizó el coeficiente alfa de Cronbach. La validez del constructo se evaluó por medio de Análisis Factorial Exploratorio y Análisis Factorial Confirmatorio. Resultados: el Instrumento de Evaluación de la Experiencia del Paciente Crónico obtuvo un coeficiente alfa de Cronbach total de 0,75. El Análisis Factorial Exploratorio recomendó unidimesionalidad del instrumento, que fue ratificada por medio del Análisis Factorial Confirmatorio, con índices que indicaron buenos ajustes de acuerdo con los criterios establecidos. Los resultados indicaron los siguientes valores: χ2/g = 1,129; Goodness-of-Fit Index = 0,96; Root-Mean-Square Error of Approximation = 0,050; Tucker-Lewis Index = 0,97 y Adjusted Goodness-of-Fit Index = 0,94. Conclusión: el Instrumento de Evaluación de la Experiencia del Paciente Crónico presenta satisfactorias evidencias de confiabilidad y validez en pacientes con enfermedad renal crónica sometidos a hemodiálisis.

RESUMO Objetivo: analisar as propriedades métricas da versão adaptada do Instrumento de Evaluación de la Experiencia del Paciente Crónico para o português do Brasil. Método: trata-se de um estudo metodológico e transversal, realizado com 132 pacientes com doença renal crônica que realizam hemodiálise. Na avaliação da confiabilidade, utilizou-se o alfa de Cronbach. A validade de construto foi avaliada por meio da análise fatorial exploratória e da análise fatorial confirmatória. Resultados: o Instrumento de Evaluación de la Experiencia del Paciente Crónico obteve um alfa de Cronbach total de 0,75. A unidimesionalidade do instrumento foi recomendada na análise fatorial exploratória e ratificada por meio da análise fatorial confirmatória, com os índices indicando bons ajustes, de acordo com os critérios estabelecidos. Os resultados indicaram os seguintes valores: χ2/g =1,129; Godness-of-Fit Index = 0,96; Root-Mean-Square Error of Approximation= 0,050; Tucker-Lewis Index =0,97 e Adjusted Goodness-of-Fit Index =0,94. Conclusão: o Instrumento de Evaluación de la Experiencia del Paciente Crónico possui evidências de confiabilidade e validade satisfatórias em pacientes com doença renal crônica que realizam hemodiálise.

RESUMO

La tercera causa de morbi-mortalidad en muchos países, es el accidente cerebrovascular (ACV), la incidencia es mayor en los pacientes con hemodiálisis. La presencia del ACV hemorrágico se vincula con peores resultados; el diagnóstico y tratamiento precoces son primordiales por la rápida expansión de la misma, que provoca un detrimento neurológico, hasta un desenlace fatal. Se presenta el caso de una mujer de 52 años, ingresa por servicio de emergencia en fecha 23/05/23 con antecedente de terapia de reemplazo renal tri-semanal, hipertensión arterial, diabetes mellitus; cuadro clínico con cefalea súbita, de moderada intensidad, acompañado de somnolencia, entumecimiento a nivel de columna cervicodorsal, paraparesia en extremidades inferiores e hipertensión; tomografía de cráneo con ACV hemorrágico pre tallo cerebral; ingresa a la Unidad de Terapia Intensiva (UTI) para monitorización y manejo, sin embargo a pesar del tratamiento evoluciono de manera tórpida y fallece en fecha 11/06/2023.

The third cause of morbidity and mortality in many countries is cerebrovascular accident (CVA), the incidence is higher in hemodialysis patients. The presence of hemorrhagic stroke is associated with worse results; early diagnosis and treatment are essential due to its rapid expansion, which causes neurological detriment, up to a fatal outcome. The case of a 52-year-old woman is presented, admitted for emergency service on 05/23/23 with a history of three-weekly renal replacement therapy, arterial hypertension, diabetes mellitus; clinical picture with sudden headache of moderate intensity, accompanied by drowsiness, numbness at the level of the cervicodorsal spine, paraparesis in the lower extremities and hypertension; skull tomography with pre-brain stem hemorrhagic stroke; he was admitted to the Intensive Care Unit (ICU) for monitoring and management, however despite the treatment he evolved torpidly and died on 06/11/2023.

RESUMO

Grande parte dos pacientes em hemodiálise estão em idade laboral, acarretando um desafio na manutenção do seu trabalho. Realizou-se um estudo transversal em centros de hemodiálise no norte de Santa Catarina, entre dezembro de 2020 a fevereiro de 2021. Incluiu-se pacientes entre 18 e 55 anos em hemodiálise há mais de 3 meses. Avaliou-se aspectos relacionados ao trabalho, sua manutenção após início da hemodiálise e a qualidade de vida através do instrumento SF-36. A condição laboral foi avaliada com relação a qualidade de vida através de regressão logística. Dos 108 pacientes, a média de idade foi 43,34 ±8,88 anos, com mediana do tempo em diálise de 19 meses. Dos participantes, 78,9% estavam trabalhando seis meses antes do início da hemodiálise e 39,8% após 6 meses. Não houve diferença em relação ao sexo, idade e estado civil com relação ao trabalho antes ou após 6 meses do início da hemodiálise. Trabalhar foi associado a uma maior qualidade de vida, mesmo após ajuste para outras variáveis (OR=5,30; 95% IC 1,43-19,61, p=0,013). Conclui-se que existe importante queda da manutenção do emprego após início da hemodiálise. O estímulo a manutenção do trabalho pode favorecer uma melhor qualidade de vida nestes pacientes.

Most patients undergoing hemodialysis are of working age, and this poses a challenge in maintaining their jobs. A crosssectional study was carried out in hemodialysis centers in the north of Santa Catarina, between December 2020 and February 2021. Patients aged between 18 and 55 years old on hemodialysis for more than 3 months were included. Aspects related to work, remaining at their job after starting hemodialysis, and quality of life were evaluated using the SF-36 instrument. Their working situation was evaluated in relation to quality of life through logistic regression. Of the 108 patients, the mean age was 43.34 ± 8.88 years old, with a median time on dialysis of 19 months. Of the participants, 78.9% were working six months before starting hemodialysis and 39.8% were working 6 months after. There was no difference in terms of sex, age, and marital status with regards to work before or after 6 months of starting hemodialysis. Working was associated with a better quality of life, even after adjusting for other variables (OR=5.30; 95% CI 1.43-19.61, p=0.013). It is concluded that there is a significant drop in employment after starting hemodialysis. The stimulus to keep working can favor a better quality of life in these patients.

RESUMO

Introducción: Los pacientes con insuficiencia renal crónica en tratamiento de hemodiálisis constituyen un importante grupo de riesgo para adquirir la infección por el virus C de la hepatitis. Objetivo: Caracterizar a portadores del virus C de la hepatitis en tratamiento de hemodiálisis según variables clinicoepidemiológicas y endoscópicas. Métodos: Se realizó una investigación observacional, descriptiva, retrospectiva y longitudinal de 63 pacientes con insuficiencia renal crónica, en tratamiento de hemodiálisis, portadores del virus C de la hepatitis, quienes fueron atendidos en la consulta de Gastroenterología del Hospital General Docente Dr. Juan Bruno Zayas de Santiago de Cuba, desde enero de 2015 hasta septiembre de 2019. Resultados: En la investigación primaron el sexo masculino, el grupo etario de 31-60 años, además de la hipertensión arterial y la diabetes mellitus como antecedentes personales. Los factores de riesgo de mayor incidencia fueron las inyecciones y las transfusiones frecuentes. Conclusiones: Existió una correlación significativa entre el tiempo en hemodiálisis y el tiempo de diagnóstico del virus C de la hepatitis; sin embargo, la replicación viral se mantuvo baja.

Introduction: The patients with chronic renal failure in hemodialysis treatment constitute an important risk group to acquire the infection for the viral hepatitis C. Objective: To characterize carriers of the viral hepatitis C in hemodialysis treatment according to clinical epidemiological and endoscopic variables. Methods: An observational, descriptive, retrospective and longitudinal investigation of 63 patients with chronic renal failure, in hemodialysis treatment, carriers of the viral hepatitis C was carried out, who were assisted in the Gastroenterology Service of Dr. Juan Bruno Zayas Teaching General Hospital in Santiago de Cuba from January, 2015 to September, 2019. Results: In the investigation there was a prevalence of the male sex, the 31-60 age group, besides hypertension and the diabetes mellitus as personal history. The risk factors of more incidence were injections and frequent transfusions. Conclusions: There was a significant correlation between the time in hemodialysis and the time of diagnosis of the viral hepatitis C; however, the viral replication stayed low.

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