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

Introduction: Acute kidney injury (AKI) is a common complication in the postoperative period of heart transplantation and is associated with unfavorable patient outcomes.

Objective: To analyze the incidence of AKI in patients undergoing heart transplantation and to identify preoperative, intraoperative, and postoperative risk factors associated with its development.

Methods: This was a single-center retrospective cohort study including patients who underwent heart transplantation during the first three years of the program at a tertiary hospital in the State of São Paulo, from January 2020 to January 2023. Patients with chronic kidney disease (CKD) stages 4 or 5 and prior kidney transplantation were excluded.

Results: The incidence of AKI was 48%. Logistic regression analysis demonstrated an association between AKI and the following factors: pre-existing CKD (OR = 3.155; 95% CI 1.343-6.340; p = 0.031), cold ischemia time (OR = 1.956; 95% CI 1.126-3.053; p = 0.042), and higher doses of norepinephrine in the first postoperative day (OR = 5.211; 95% CI 2.696-8.987; p = 0.028). There was no significant difference in mortality between patients who developed AKI and those who did not (58.3% vs. 38.5%; p = 0.09).

Conclusion: The incidence of AKI was high (48%) in this population. The main risk factors for its development were pre-existing CKD, prolonged cold ischemia time, and higher doses of norepinephrine in the first postoperative day.

Introduction: The impact of curcumin on the gut microbiota of chronic kidney disease (CKD) patients is not well known. The aim of this study was to evaluate the effect of Curcuma longa L. on the gut microbiota of CKD patients undergoing hemodialysis (HD).

Methods: This was a secondary analysis of data from a randomized, double-blind, placebo-controlled trial. Patients received 100 mL of orange juice, 12 grams of carrot, and 2.5 grams of Curcuma longa L. three times a week after the HD session (Curcuma group) or the same juice without added curcumin (control group) for 12 weeks. The fecal microbiota composition was estimated using short-read sequencing of the V4 region of the 16S rRNA gene on the Illumina platform.

Results: Eleven patients participated in this study, five in the curcumin group (66.7% male, 59 ± 16.7 years old, HD vintage of 97 ± 62.6 months, BMI 25.3 ± 2.9 kg/m2) and six in the control group (60% male, 57.5 ± 12.5 years old, HD vintage of 48.3 ± 32.2 months, BMI 25.2 ± 3.1 kg/m2). Supplementation with Curcuma longa L. extract did not modify alpha biodiversity or the taxonomic composition of individuals at the phylum, family, and genus levels.

Conclusion: Supplementation with 2.5 g of Curcuma longa L. extract three times per week for 12 weeks was inefficient in modulating the gut microbiota of CKD patients undergoing HD. These results should be interpreted taking into account the small sample size, and future studies with larger cohorts are encouraged.

Introduction: High-volume, conventional thrice-weekly hemodiafiltration appears to provide better outcomes than conventional hemodialysis. We aimed to evaluate whether the benefits of performing hemodiafiltration can be combined with those of frequent hemodialysis.

Methods: This was a single-center, longitudinal, A1-B-A2 design study that compared high-flux short daily hemodialysis (SDHD) with post-dilution online short daily hemodiafiltration (SDHDF).

Results: Twelve patients completed the study. Myoglobin clearance was greater during SDHDF (45.95 ± 11.0 mL/min) than during SDHD1 (20.11 ± 5.2 mL/min, P < 0.01) and SDHD2 (21.39 ± 3.55 mL/min, P < 0.01). A slightly higher pre-dialysis mean arterial pressure was observed during SDHDF (102.51 ± 11.28 mmHg) compared with SDHD1 (95.5 ± 9.82 mmHg, P < 0.01) and SDHD2 (97.61 ± 11.19 mmHg, P = 0.03). We also detected an increase in pre-dialysis hemoglobin during SDHDF (12.39 ± 1.2 g/dL) compared to SDHD1 (11.30 ± 1.09 g/dL, P = 0.02) and SDHD2 (11.23 ± 1.84 g/dL, P < 0.01). HDL-cholesterol was significantly higher at the end of the SDHDF period (52.75 ± 15.8 mg/dL) compared to SDHD1 (47.00 ± 10.8 mg/dL, P = 0.01) and SDHD2 (43.75 ± 11.1 mg/dL, P < 0.01) periods.

Conclusion: The effect of converting SDHD to SDHDF was slightly positive in our study. In the long term, short daily hemodiafiltration might have more benefits for the dialysis population. This can lead to the adoption of hemodiafiltration as the standard of care even in the frequent hemodialysis setting.

Introduction: The medical residency (MR) curriculum underwent a reformulation, and in 2021, the competency matrix for MR in nephrology was published. This study aimed to evaluate nephrologists' perceptions of the competencies acquired during residency and their relevance in clinical practice.

Method: This was a cross-sectional study conducted using a self-administered electronic questionnaire, which included demographic data, information on professional practice, and an assessment of both the learning and the usefulness of the skills acquired during the MR program in nephrology. Participants responded to questions on a five-point Likert scale. Only nephrologists who had graduated from programs accredited by the Brazilian Ministry of Education were included.

Results: A total of 163 nephrologists from different states in Brazil were included. Most considered the clinical skills acquired to be useful for practice, except for palliative care, in which 54% felt capable, although 93.2% considered it essential. Procedures for which usefulness exceeded self-reported competence included fundoscopy, insertion of permanent hemodialysis catheters, insertion of peritoneal dialysis catheters, and ultrasonography. Furthermore, less than 40% of participants reported feeling prepared to engage in management, clinical research, and teaching activities, despite perceiving their relevance.

Conclusion: The study highlights nephrologists' perceptions of competencies acquired during MR and underscores the need for improvements in nephrology training, particulary in management, teaching, and research.

The increase use of vaping, especially in the younger population, has led to increased scrutiny of its health effects, particularly on renal function. This article reviews the current literature on the association between vaping, nicotine exposure, and renal impairment, focusing on the development of acute kidney injury (AKI) and chronic kidney disease (CKD). Nicotine and other chemicals in e-liquids may induce microangiopathy, leading to vasoconstriction and reduced renal perfusion, thus contributing to AKI. Chronic exposure to nicotine also promotes an inflammatory response, increasing the risk of interstitial nephritis. Additionally, glomerular damage due to continuous use of vapers has been linked to albuminuria and progression of focal segmental glomerulosclerosis (FSGS), a condition that can lead to CKD. This article highlights the need for further research to clarify the kidney risks associated with vaping and provides information for public health policies on nicotine use.