Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia最新文献

In January 2026, the new Dietary Guidelines for Americans were released, generating substantial international debate. Unlike previous editions, these guidelines were not primarily based on the report of the Dietary Guidelines Advisory Committee but on an independent scientific review, a process that raised concerns regarding transparency and potential conflicts of interest. This article critically examines the main recommendations of the new Dietary Guidelines for Americans, with particular emphasis on their implications for metabolic, cardiovascular, and kidney health. While the guidelines appropriately emphasize the reduction of ultra-processed food consumption and the promotion of minimally processed foods, several inconsistencies with contemporary scientific evidence are identified. Key concerns include the use of an outdated inverted food pyramid, a strong emphasis on high-protein intake (1.2-1.6 g/kg/day) predominantly from animal sources, and an internal contradiction between recommended protein intake and limits on saturated fat consumption. The proposed dietary pattern may also inadequately support gut microbiota health due to relatively low recommendations for fruits, vegetables, and whole grains. These issues may also be relevant to nephrology, given the growing popularity of high-protein diets and their potential renal implications. Overall, while the guidelines contain positive elements, their scientific coherence and alignment with established evidence-based dietary patterns remain questionable, potentially limiting their effectiveness as a public health tool.

Introduction: The annual Brazilian Dialysis Survey (BDS) plays an important role in informing and shaping national health policies.

Objective: To present the 2024 epidemiological findings from the BDS conducted by the Brazilian Society of Nephrology (BSN) and compare them with previous years.

Methods: A survey was conducted among Brazilian chronic dialysis centers through voluntary participation, utilizing an online questionnaire to assess clinical and epidemiological characteristics of dialysis patients, as well as dialysis center attributes. For specific estimates of prevalence, incidence, and funding source, a nationally representative random sample of dialysis centers stratified by geographic region was selected (n = 258).

Results: A total of 386 dialysis centers (42.7%) voluntarily responded to the online questionnaire, and 162 centers from the randomly selected centers provided data. On July 1st, 2024, the estimated number of dialysis patients was 172,585, with 52,944 new patients starting dialysis in 2024. The estimated prevalence and incidence rates per million population (pmp) were 812 and 249, respectively. Among prevalent patients, 87.3% were undergoing hemodialysis, 7.1% hemodiafiltration, and 5.6% peritoneal dialysis. Compared to the previous year, there was an increase in catheter use for hemodialysis vascular access, along with higher prevalence rates of anemia, hyperphosphatemia, hyper-kalemia, and low Kt/V. The estimated crude annual mortality rate was 16.5%.

Conclusions: Data from a random sample of dialysis centers indicate a continued rise in the number and prevalence of chronic dialysis patients in Brazil. Worsening trends in permanent vascular access, dialysis adequacy, and metabolic control underscore the need for targeted improvements in patient care.

The increase in chronic kidney disease prevalence and its risk factors have pressured universal health systems to expand the supply of kidney replacement therapy (KRT - hemodialysis, peritoneal dialysis and kidney transplantation). Particularly in low- and middle-income countries and those undergoing a fast epidemiological and demographic transition, the access to nephrology consultations and multidisciplinary care is limited, and the majority of patients start KRT in an unplanned manner or during emergency hospitalization. Even patients with adequate pre-dialysis care and elective requests for KRT are at risk of clinical decompensation and requiring hospitalization to start emergency dialysis; this risk increases the longer the delay in starting KRT. In both cases, the patient's access to an outpatient dialysis unit must be timely and the transition of care safe. There are Brazilian and international guidelines for patients who are prevalent on dialysis. However, there are no clear recommendations for regulating access to the start of outpatient KRT, which often leads to divergent opinions among healthcare professionals and contributes to the inefficiency of the regulatory process. This document aims to: (1) list the main challenges in the daily practice of the regulatory professionals in the Brazilian Unified Health System; (2) present recommendations from the Brazilian Society of Nephrology based on scientific evidence and available legislation.

Introduction: Gut dysbiosis is commonly observed in patients with diabetic kidney disease (DKD) and may contribute to its pathogenesis. Among microbial metabolites, butyrate plays a key role in regulating antioxidant proteins in type 2 diabetes mellitus (T2DM). Based on this, we hypothesized that the administering probiotics to diabetic rats modulates redox status and thereby attenuates renal disease progression.

Methods: An in vivo study was performed using 15 male Wistar rats (8 weeks old, 250-300 g) randomized into three groups (n = 5/group): Control (vehicles: 0.9% saline and 0.1 M citrate, pH 4.2, i.p., on day 1), T2DM (nicotinamide 100 mg/kg, i.p., followed by streptozotocin 60 mg/kg, i.p., in 0.1 M citrate buffer, pH 4.2), and T2DM + Prob (T2DM protocol plus a multistrain probiotic-Bifidobacterium longum, Bifidobacterium bifidum, and Lactobacillus rhamnosus-1010 CFU/mL by gavage for 6 weeks). The parameters evaluated were: serum creatinine, inulin clearance, microalbuminuria, urinary and lipid peroxides, glutathione, and nuclear factor erythroid 2-related factor 2 (Nrf2).

Results: Probiotic treatment significantly increased Nrf2 expression and glutathione levels, reduced urinary and lipid peroxidation, and-beyond attenuating oxidative stress-improved renal function, with lower serum creatinine and microalbuminuria and higher inulin clearance.

Conclusion: These findings indicate that probiotics prevented DKD progression, likely by modulating oxidative stress via the gut microbiota. These results suggest that probiotics may serve as renoprotective agents, potentially reducing DKD morbidity in T2DM.

Introduction: Chronic kidney disease (CKD) is a progressive illness with high morbidity and mortality that warrants early and accurate risk stratification for optimal management. The traditional biomarkers, serum creatinine and estimated glomerular filtration rate (eGFR), are insufficient for detecting early CKD and long-term prognosis. Novel biomarkers have emerged as effective tools to complement CKD diagnosis, prognosis, and therapeutic monitoring.

Aim: The aim of this research was to determine the potential of novel biomarkers in CKD risk stratification and their clinical significance for improving early detection, monitoring disease progression, and developing individualized treatment strategies.

Methods: A literature review was conducted by searching the PubMed, Scopus, and Embase databases to identify studies on novel CKD biomarkers, including cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and specific microRNAs.

Results: Emerging evidence suggests that novel biomarkers provide superior predictive abilities compared to traditional markers. Cystatin C is more accurate in kidney function estimation, whereas NGAL and KIM-1 are markers of early kidney injury. MicroRNAs show potential in distinguishing between CKD subtypes and predicting disease progression. Clinical application of these biomarkers may enhance CKD risk stratification, allowing more targeted intervention strategies.

Conclusion: New biomarkers in CKD risk stratification represent a watershed moment in nephrology, offering improved early detection and prognostic accuracy. While promising, additional large-scale research and clinical validation are required before they can be used routinely.

Introduction: The high rate of people with chronic kidney disease on dialysis is a public health problem, especially in developing countries.

Objectives: To evaluate demographic and socioeconomic changes related to dialysis treatment in Brazil from 2002 to 2019.

Methods: This descriptive, analytical study reviewed retrospective documentary data. A comparative analysis was conducted on demographic, economic, and social trends, as well as changes in dialysis service provision in Brazil between 2002 and 2019. Correlation analysis between Municipal Human Development Index (HDI-M) and the number of dialysis units was performed.

Results: There was an increase in the percentage of the older population (5.3% vs. 9.25%) and in life expectancy at birth (70.8 vs. 75.9 years). The gross domestic product (GDP) increased by 453%; the percentage of investment in public health (below 4%) was stable and the ranking of global Human Development Index decreased (73 vs 84). The increase in the prevalence of patients on chronic maintenance dialysis was greater than the increase in the number of patients in new centers (117.3% vs. 43.9%), with fewer patients receiving treatment in the North and Northeast regions. There was a positive linear correlation between the HDI-M values and the number of dialysis units (R = 0.52; 95% CI: 0.75-0.18; p = 0.006).

Conclusion: Despite Brazil's strong economic growth and the drastic demographic changes that occurred during the study period, this progress did not translate into a higher investment in health and equitable access to dialysis treatment across the country.

Kidney Paired Donation (KPD) is a transformative strategy in living kidney donor transplantation (LDKT), particularly for overcoming immunological barriers that preclude direct donation. In 2021, KPD accounted for one-fifth of adult LDKT and for half of LDKT for sensitized recipients in the United States. In Brazil, with a high prevalence of chronic kidney disease (CKD) and over 30,000 patients on transplant waiting lists, the demand for compatible donors far exceeds supply. This article presents a case report of KPD in the Brazilian context, illustrating its feasibility and highlighting challenges and considerations for broader implementation. The case demonstrates KPD's potential to increase transplant rates, improve outcomes, and reduce dialysis costs. Nevertheless, structural, ethical, and regulatory challenges remain. This report emphasizes the implications of expanding KPD as a sustainable, life-saving strategy in Brazil.