The incidence of chronic kidney disease (CKD) is increasing with the increasing age of the population and the increasing number of elderly survivors of acute kidney injury (AKI). The risk factors for the progression of CKD after AKI are unclear.
To investigate the association between AKI and its progression to CKD and the risk factors involved.
An observational, retrospective study of AKI patients followed from 2009 to 2012 was carried out. We evaluated the etiology of AKI, the use of vasoactive drugs and mechanical ventilation, the need for dialysis, the presence of comorbidities, the glomerular filtration rate (GFR), the length of stay and the progression of CKD. Statistical analyses, including the Chi-square test and Pearson's correlation, were performed using SPSS.
The 207 patients analyzed had a mean age of 70.1 ± 13.1, and 84.6% of
the male patients exhibited decreased renal function and CKD
Being an elderly male patient with AKI due to sepsis and obstruction was correlated with progression to CKD following discharge.
Keywords: Lesão renal aguda; nefropatias; falência renal crônica; diálise renal; diálise;
Cardiovascular disease (CVD) is especially prevalent in patients with chronic kidney disease (CKD).
To evaluate the role of CKD and metabolic syndrome (MS), which is a cluster of risk factors for CVD, as predictors of CVD.
Observational, cross-sectional study with a random sample aged 45 or more years extracted from the population assisted by the primary care program in Niterói city in the state of Rio de Janeiro, Brazil. CKD was diagnosed by the K/DOQI guidelines and MS, by the harmonized criteria. CVD was said to be present if the participant had one or more of the following findings: echocardiographic abnormalities, and history of myocardial infarction, stroke or heart failure. A logistic regression model was developed to analyze risk factors for CVD using CKD as the variable of primary interest.
Fifty hundred and eighty-one participants (38.2% male) with a mean age of
59.4 ± 10.2 years were analyzed. The prevalence rate of CKD was
27.9%. In participants without CKD, MS was associated with a slight but
statistically significant increase in the risk for CVD (OR = 1.52,
In this study involving a population assisted by a primary care program, CKD was confirmed as an independent risk factor for CVD. The presence of MS concurrent with CKD substantially amplified the risk for CVD.
Keywords: renal insufficiency, chronic; cardiovascular diseases; metabolic syndrome X; primary health care;
Chronic kidney disease (CKD) is associated with high morbidity and mortality rates, main causes related with cardiovascular disease (CVD) and bone mineral disorder (CKD-BMD). Uremic toxins, as advanced glycation end products (AGEs), are non-traditional cardiovascular risk factor and play a role on development of CKD-BMD in CKD. The measurement of skin autofluorescence (sAF) is a noninvasive method to assess the level of AGEs in tissue, validated in CKD patients.
The aim of this study is analyze AGEs measured by sAF levels (AGEs-sAF) and its relations with CVD and BMD parameters in HD patients.
Twenty prevalent HD patients (HD group) and healthy subjects (Control group, n = 24), performed biochemical tests and measurements of anthropometric parameters and AGEs-sAF. In addition, HD group performed measurement of intact parathormone (iPTH), transthoracic echocardiogram and radiographies of pelvis and hands for vascular calcification score.
AGEs-sAF levels are elevated both in HD and control subjects ranged according to the age, although higher at HD than control group. Single high-flux HD session does not affect AGEs-sAF levels. AGEs-sAF levels were not related to ventricular mass, interventricular septum or vascular calcification in HD group. AGEs-sAF levels were negatively associated with serum iPTH levels.
Our study detected a negative correlation of AGEs-sAF with serum iPTH, suggesting a role of AGEs on the pathophysiology of bone disease in HD prevalent patients. The nature of this relation and the clinical application of this non-invasive methodology for evaluation AGEs deposition must be confirmed and clarified in future studies.
Keywords: hemodiálise; hormônio intacto da paratireoide; doenças cardiovasculares; doenças ósseas; produtos finais de glicosilação avançada;
National chronic dialysis data are important for the treatment planning.
To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2016.
A survey based on data of dialysis centers from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis centers.
309 (41%) of the dialysis units in the country answered the questionnaire. In July 2016, the total estimated number of patients on dialysis was 122,825. The estimated prevalence and incidence rates of chronic maintenance dialysis were 596 (range: 344 in the North region and 700 in the Southeast) and 193 patients per million of population (pmp), respectively. The annual incidence rate of patients with diabetic nephropathy was 79 pmp. The annual gross mortality rate was 18.2%. For prevalent patients, 92% were on hemodialysis and 8% on peritoneal dialysis, and 29,268 (24%) were on a waiting list of renal transplant. A venous catheter was the vascular access for 20.5% of the hemodialysis patients. The prevalence rates of positive serology for hepatitis B and C showed a tendency to reduce from 2013 (1.4% and 4.2%, respectively) to 2016 (0.7% and 3.7%, respectively).
The absolute number and the prevalence and incidence rates of patients on dialysis continue to rise steadily; the gross mortality rate remained stable. Regional inequities are evident in these rates.
Keywords: falência renal crônica; diálise renal; dados censitários; epidemiologia;
Data on impact of high body mass index (BMI) on mortality of patients on peritoneal dialysis (PD), especially among elderly, are inconsistent. Objective: To evaluate impact of BMI on cohort of incident elderly PD patients over time.
Prospective multicenter cohort study (December / 2004-October/2007) with 674 patients.
Socio-demographic and clinical data evaluated with patients followed until death,
transfer to hemodialysis (HD), recovery of renal function, loss of follow-up or
transplant. Patients were divided into incident on renal replacement therapy (RRT) for
PD (PD first: 230) and transferred from hemodialysis (HD first: 444). Analysis was
performed comparing these two groups using chi-square or Kruskal Wallis. Similar
analysis was used to compare patients on automated peritoneal dialysis (APD)
Malnourished patients (76.79 ± 7.53 years) were older (
Increased BMI variation over time proved to be a protective factor, with a decrease of about 1% in risk of death for every BMI unit earned.
Keywords: índice de massa corporal; idoso; diálise peritoneal;
Patients on hemodialysis (HD) present high mortality from cardiovascular complications and high morbidity, including decreasing functional capacity and quality of life.
To analyze clinical and laboratory responses of patients in HD to intradialytic cardiopulmonary rehabilitation on an outpatient basis.
We evaluated 14 patients in a prospective study for 8 months using cardiopulmonary rehabilitation protocol (CRehab) consisted of intradialytic aerobic exercise with a cycle ergometer. We analyzed heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), peripheral oxygen saturation (SpO2) and modified Borg scale. We evaluated cardiac function by echocardiogram, functional capacity by six minutes walk test (6MWT), and quality of life by SF-36 survey, before and after CRehab. Biochemical data and KT/Vsp were collected form medical records.
During CRehab, the results of HR, SBP, DBP, SpO2 and Borg scale showed no
significant changes. 6MWT test showed progressive increase in the distance covered
The intradialytic CRehab applied in this population was safe and allowed objective improvement of functional capacity and exercise tolerance, subjective improvement in the perception of effort, significant increase in cardiac function and better quality of life in different domains.
Keywords: doença renal crônica; diálise renal; qualidade de vida; exercício;
The mortality of the population with chronic kidney disease (CKD) on hemodialysis (HD) is very high and the protein-energy malnutrition stands out as one of the most common consequences in relation to this condition.
To evaluate the association between time of hemodialysis and nutritional parameters of patients.
It is a cross-sectional study with secondary data, developed of the University Hospital of the Federal University of Juiz de Fora (HU/UFJF). This study was approved by the Research Ethics Committee (Nº 1.233.142), a total of 36 patients. The medical records and collected data were analyzed for anthropometric markers, biochemical and diet, considering two groups: HD time less than three and greater than or equal to three years.
There was reduction of mass of somatic protein with increased duration of HD. In
relation to food intake was observed that in patients with increased duration of
dialysis, an increase in average consumption of protein / kg of weight, calories,
phosphorus and potassium, with a significant difference from the mean protein intake /
HD patients are a risk group for protein-energy malnutrition, where HD time interferes with the nutritional status and food profile of the patient. The group HD time greater than or equal to 3 years presented worsening nutritional status.
Keywords: diálise renal; estado nutricional; desnutrição proteica; insuficiência renal; avaliação nutricional;
Kidney transplantation is considered a cost-effective treatment compared to dialysis but accounts for a significant percentage of the public health care resources. Therefore, efficient systems capable of performing high number of procedures are attractive and sustainable.
The aim of this study was to evaluate clinical outcomes of 11,436 kidney transplants regularly performed in a single transplant dedicated center over the last 18 years.
This was a retrospective study performed in a single specialized transplant center. All consecutive patients who underwent transplantation between 08/18/1998 and 12/31/2015 were included in the analysis.
The annual number of transplants increased from 394 in 1999 to 886 in 2015,
with a progressive reduction in the proportion of living donor kidney
The implementation of a dynamic and efficacious health care system was associated with a progressive increase in the number of kidney transplants, in the cumulative number of patients in follow up and a shift from living related to deceased donor kidney transplants, with associated progressive increase in patient and graft survivals.
Keywords: transplante de rim; avaliação de resultados (cuidados de saúde); gestão da informação em saúde; imunossupreção;
Bacterial or viral diseases are one of the major causes of death in patients with chronic kidney disease (CKD). These patients show a quantitative reduction of levels of antibodies over time. Among the infectious diseases that affect CKD patients, stands out hepatitis B (HB). Immunization and control of antibodies levels against the hepatitis B surface antigen (anti-HBs) are ways to prevent the HB infection in this population. Patients with anti-HBs levels ≥10 IU/ml are considered adequate responders, whereas those with anti-HBs levels ≥ 100 IU/ml are considered excellent responders.
To analyze the variation of the anti-HBs levels obtained after vaccination against HB in children and adolescents in the pre-dialysis stage of CKD.
A retrospective cohort study on anti-HBs levels of children and adolescents in the pre-dialysis stage of CKD. Correlation between levels of anti-HBs titers and time since the vaccination were estimated.
From the total of 116 studied patients most of the studied patients were
considered excellent responders, obtaining in the three anti-HBs titers
percentages of 70.7%, 62.1% and 54.9% respectively. The anti-HBs titer
levels showed a negative correlation with the time since vaccination
(Kendall Tau-b = -0.16;
The majority of the studied population was vaccinated by PNI and showed excellent anti-HBs titer levels, even experiencing a progressive reduced response over the time.
Keywords: insuficiência renal crônica; hepatite B; imunização; pediatria;
Metabolic acidosis is highly prevalent in hemodialysis patients. The disorder is associated with increased mortality and its deleterious effects are already present in the predialysis phase of chronic kidney disease. Metabolic acidosis has been linked to progression of chronic kidney disease, changes in protein and glucose metabolism, bone and muscle disorders and cardiovascular disease. At present, the control of metabolic acidosis in hemodialysis is mainly focused on the supply of bicarbonate during dialysis session, but further studies are needed to set the optimum target serum bicarbonate and the best concentration of the bicarbonate dialysate. The present study reviews pathophysiological and epidemiological aspects of metabolic acidosis in hemodialysis patients and also addresses its adverse effects and treatment.
Keywords: acidose; diálise renal; bicarbonatos;
Renouncement of renal replacement therapy (RRT) is a medical dilemma. This review covers the concept, the magnitude, the prognosis, and discusses strategies and management approaches about this subject in patients with CKD and AKI. Evidence suggests that refusal is more frequent and carries a more guarded prognosis than withdrawal of RRT. When RRT is not expected to be beneficial in terms of survival or quality of life, conservative treatment and palliative care are alternatives. We review the historical evolution of guidelines about renouncement of RRT and palliative care, and highlight the absence of specific recommendations in Brazil. However renouncement of RRT may be ethically and legally accepted in Brazil, as the right to a dignified death. Longer life expectancy, economic pressures, and greater awareness will require a more detailed discussion about indications and sustainable use of RRT, and possibly the elaboration of national guidelines.
Keywords: diálise; diálise renal; cuidados paliativos; bioética; lesão renal aguda; terapia de substituição renal; geriatria; futilidade médica; suspensão de tratamento; insuficiência renal crônica;
Sepsis is the most common cause of death in critically ill patients and it may be associated with multiorgan failure, including acute kidney injury (AKI). This situation can require acute renal support and increase mortality. Therefore, it is essential to administrate antimicrobials in dosis to achieve adequate serum levels, preventing overdosis and drug toxicity or underdosing and risk for resistance to antibiotics and higher mortality. To date, there aren't validated guidelines on antibiotic dosis adjustment in septic patients with AKI and the recommendations are extrapolated from studies conducted in non-critical patients with chronic kidney disease in end stage receiving chronic renal replacement therapy. This study aimed to review and discuss the complexity of that issue, considering the several factors related to the drugs removal: critically ill patient characteristics, antimicrobial properties and dialysis method.
Keywords: lesão renal aguda; unidades de terapia intensiva; antibacterianos;
Acquired Cystic Kidney Disease (ACKD) is regarded as a common late condition of end stage renal damage and expresses its most important features when associated with long term hemodialysis. ACKD is also widely known as a premalignant lesion. Its occurrence in chronically rejected renal allografts is rare and its frequency and behavior in this setting are not well known. Herein we report a case of ACKD in a long standing nonfunctional allograft (215 months) which is not associated with malignancy and briefly review the related literature.
Keywords: doenças renais císticas; transplante de rim; transplante homólogo;
Fabry disease is an X-linked lysosomal storage disease due to alpha-galactosidase A (α-Gal A) deficient activity which leads to the accumulation of glucoesphingolipids, such as globotriaosilceramide. There are over 700 known mutations of the enzyme gene, and most of them cause Fabry Disease. This case report describes a hemodialysis patient with a rare and controversial GLA gene mutation, the D313Y. The medecial investigation confirmed that D313Y is an alpha-galactosidase A sequence variant that causes pseudo deficient enzyme activity in plasma but not Fabry disease. Thus, clinical symptoms that prompted Fabry disease investigation could not be attributable to Fabry disease and therefore enzyme replacement therapy was not indicated.
Keywords: doença de Fabry; diagnóstico; doenças genéticas ligadas ao cromossomo X; alfa-galactosidase; diálise renal; mutação;
The main causes of hypokalemia are usually evident in the clinical history of patients, with previous episodes of vomiting, diarrhea or diuretic use. However, in some patients the cause of hypokalemia can become a challenge. In such cases, two major components of the investigation must be performed: assessment of urinary excretion potassium and the acid-base status. This article presents a case report of a patient with severe persistent hypokalemia, complementary laboratory tests indicated that's it was hypomagnesaemia and hypocalciuria associated with metabolic alkalosis, and increase of thyroid hormones. Thyrotoxic periodic paralysis was included in the differential diagnosis, but evolved into euthyroid state, persisting with severe hypokalemia, which led to be diagnosed as Gitelman syndrome.
Keywords: hipopotassemia; síndrome de Gitelman; hipertireoidismo; paralisia periódica hipopotassêmica;
Keywords: endocardite; endocardite bacteriana; transplante de rim;
In a recent review article, authors suggest lowering the diagnostic threshold for chronic kidney disease (CKD) in the elderly population. Here, it is discussed the possible implications of that proposed change.
Keywords: geriatria; nefropatias; taxa de filtração glomerular; nefrologia;