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

Introduction: Hemodialysis (HD) prolongs the survival of patients with end-stage chronic kidney disease (CKD), but mortality remains high due to malnutrition and inflammation. This study aimed to investigate whether low albumin levels and a reduced phase angle (PA) predict higher mortality in HD patients.

Methods: This prospective cohort study followed 82 HD patients for 36 months. Biological markers, including albumin and oxidative stress indicators, were measured before and after a single HD session upon study enrollment (time zero). PA was determined by bioimpedance analysis. Kaplan-Meier survival curves and Cox regression analyses were performed to assess the association between albumin, PA, and mortality.

Results: Patients with PA <4 had a mean survival of 11.6 months, compared to 27.0 months for those with PA ≥ 4 (HR = 5.66; 95% CI: 2.44-13.12). Similarly, patients with albumin <3.9 g/dL had significantly lower survival rates at 6, 12, and 36 months compared to those with albumin ≥3.9 g/dL (HR = 4.39; 95% CI: 1.81-10.63).

Conclusion: Low albumin levels and a reduced PA are strong predictors of mortality in HD patients. Routine monitoring and targeted interventions to improve these markers could enhance survival outcomes.

Introduction: Graduate studies in Brazil have experienced significant growth since the 1990s. Over a 40-year period, the Graduate Program in Nephrology at Unifesp has qualified 261 master's graduates, 111 doctors and 146 individuals who completed both a master's and a doctoral degree. Of these, 278 hold a degree in Medicine. Medical postgraduates were responsible for 124 master's dissertations and 243 doctoral theses completed.

Objective: This study analyzed the profile and professional trajectories of graduate students from the Nephrology Graduate Program at Unifesp.

Methods: The authors used the university's database to establish the graduates' profile and applied a questionnaire to identify their professional performance in academia and the job market. The graduates were divided into three groups: G1 - 1976 to 1997 (N = 127); G2 - 1998 to 2006 (N = 150); G3 - 2007 to 2015 (N = 241).

Results: Regarding sex, male medical graduates were responsible for 53.6% of all completion papers; however, in the most recent period, women accounted for 61% of the works. Female participation was consistently higher among graduates from other areas, at 73.8% of the total. Among the physicians, 65.5% graduated from public universities, with the first group standing out with 73%. In the other groups, 59.5% and 59.8% came from public HEIs, respectively. The overall average income reported by master's graduates responding to the questionnaire ranged from 5 to 10 minimum wages (MW), and for doctors, above 10 MW.

Conclusion: Doctoral graduates had a strong presence in academia, predominantly within the public sector.

Introduction: The Kidney Donor Profile Index (KDPI) has not been previously validated in Brazil, thus this study aimed to investigate the association between the index and one-year outcomes in kidney transplant recipients (KTRs) of standard criteria donors (SCD).

Methods: Retrospective cohort analysis including 1,943 KTRs who received kidneys from SCD between 2013 and 2017. The primary outcome was composed of death, graft loss, and 1-yr-graft function <30 mL/min/1.73m2 (eGFR, CKD-EPI). Logistic regression identified variables associated with the primary outcome, while 1-yr eGFR across KDPI strata was compared using the Kruskal-Wallis test, adjusted with the Bonferroni test.

Results: Donors were 41.0 years old, 24.9% had hypertension, 47.3% died due to cerebrovascular injury, and 48.3% had the final creatinine >1.5 mg/dL; the median of KDPI was 52%. The primary outcome occurred in 14.4% of the cases, which was associated with longer dialysis duration before transplantation (p = 0.04), CMV-related events (p = 0.03), acute rejection (p < 0.001), and KDPI strata. Compared to the 1-35% KDPI stratum, the RRs for the primary outcome were significantly higher in higher KDPI strata: 1.62 (p = 0.03) for >35-50%, 2.28 (p < 0.001) for >50-85%, and 2.23 (p = 0.01) for >85%. The 1-yr eGFR was also significantly lower in KTRs with donors in higher KDPI strata (p < 0.001).

Conclusion: The KDPI was independently associated with the primary outcome composed of death, graft loss, and 1-yr eGFR <30 mL/min/1.73 m2 in recipients of SCD donors. Despite not being previously validated for Brazilian donors, the KDPI was also significantly associated with 1-yr eGFR, delayed graft function, and acute rejection in those recipients.