Pub Date : 2024-01-01DOI: 10.1590/2175-8239-JBN-2022-0180en
Sibel Cavdar, Alev Garip Acar, Asuman Camyar, Ender Hür, Eser Yıldırım Sozmen, Sait Sen, Melih Ozısık, Yasemin Delen Akcay, Elif Duman, Sena Gönen, Fehmi Akcicek, Soner Duman
Introduction: Nephrotic syndrome (NS) is one of the reasons of end-stage kidney disease, and elucidating the pathogenesis and offer new treatment options is important. Oxidative stress might trigger pathogenesis systemically or isolated in the kidneys. Octreotide (OCT) has beneficial antioxidant effects. We aimed to investigate the source of oxidative stress and the effect of OCT on experimental NS model.
Methods: Twenty-four non-uremic Wistar albino rats were divided into 3 groups. Control group, 2 mL saline intramuscular (im); NS group, adriamycin 5 mg/kg intravenous (iv); NS treatment group, adriamycin 5 mg/kg (iv) and OCT 200 mcg/kg (im) were administered at baseline (Day 0). At the end of 21 days, creatinine and protein levels were measured in 24-hour urine samples. Erythrocyte and renal catalase (CAT) and thiobarbituric acid reactive substance (TBARS) were measured. Renal histology was also evaluated.
Results: There was no significant difference among the 3 groups in terms of CAT and TBARS in erythrocytes. Renal CAT level was lowest in NS group, and significantly lower than the control group. In treatment group, CAT level significantly increased compared with NS group. In terms of renal histology, tubular and interstitial evaluations were similar in all groups. Glomerular score was significantly higher in NS group compared with control group and it was significantly decreased in treatment group compared to NS group.
Conclusions: Oxidative stress in NS might be due to the decrease in antioxidant protection mechanism in kidney. Octreotide improves antioxidant levels and histology in renal tissue and might be a treatment option.
{"title":"Effect of octreotide on oxidative stress in the erythrocyte and kidney tissue in adriamycin-induced experimental nephrotic syndrome model.","authors":"Sibel Cavdar, Alev Garip Acar, Asuman Camyar, Ender Hür, Eser Yıldırım Sozmen, Sait Sen, Melih Ozısık, Yasemin Delen Akcay, Elif Duman, Sena Gönen, Fehmi Akcicek, Soner Duman","doi":"10.1590/2175-8239-JBN-2022-0180en","DOIUrl":"10.1590/2175-8239-JBN-2022-0180en","url":null,"abstract":"<p><strong>Introduction: </strong>Nephrotic syndrome (NS) is one of the reasons of end-stage kidney disease, and elucidating the pathogenesis and offer new treatment options is important. Oxidative stress might trigger pathogenesis systemically or isolated in the kidneys. Octreotide (OCT) has beneficial antioxidant effects. We aimed to investigate the source of oxidative stress and the effect of OCT on experimental NS model.</p><p><strong>Methods: </strong>Twenty-four non-uremic Wistar albino rats were divided into 3 groups. Control group, 2 mL saline intramuscular (im); NS group, adriamycin 5 mg/kg intravenous (iv); NS treatment group, adriamycin 5 mg/kg (iv) and OCT 200 mcg/kg (im) were administered at baseline (Day 0). At the end of 21 days, creatinine and protein levels were measured in 24-hour urine samples. Erythrocyte and renal catalase (CAT) and thiobarbituric acid reactive substance (TBARS) were measured. Renal histology was also evaluated.</p><p><strong>Results: </strong>There was no significant difference among the 3 groups in terms of CAT and TBARS in erythrocytes. Renal CAT level was lowest in NS group, and significantly lower than the control group. In treatment group, CAT level significantly increased compared with NS group. In terms of renal histology, tubular and interstitial evaluations were similar in all groups. Glomerular score was significantly higher in NS group compared with control group and it was significantly decreased in treatment group compared to NS group.</p><p><strong>Conclusions: </strong>Oxidative stress in NS might be due to the decrease in antioxidant protection mechanism in kidney. Octreotide improves antioxidant levels and histology in renal tissue and might be a treatment option.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9910847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1590/2175-8239-JBN-2023-E016en
Marcelo de Sousa Tavares
{"title":"Education and advocacy in acute kidney injury in children: a call for action.","authors":"Marcelo de Sousa Tavares","doi":"10.1590/2175-8239-JBN-2023-E016en","DOIUrl":"10.1590/2175-8239-JBN-2023-E016en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138470289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1590/2175-8239-JBN-2022-0161en
Gabriel Martins Nogueira, Paulo Novis Rocha, Constança Margarida Sampaio Cruz
Introduction: Acute kidney injury (AKI) is a frequent complication of severe COVID-19 and is associated with high case fatality rate (CFR). However, there is scarcity of data referring to the CFR of AKI patients that underwent kidney replacement therapy (KRT) in Brazil. The main objective of this study was to describe the CFR of critically ill COVID-19 patients treated with acute kidney replacement therapy (AKRT).
Methods: Retrospective descriptive cohort study. We included all patients treated with AKRT at an intensive care unit in a single tertiary hospital over a 15-month period. We excluded patients under the age of 18 years, patients with chronic kidney disease on maintenance dialysis, and cases in which AKI preceded COVID-19 infection.
Results: A total of 100 out of 1479 (6.7%) hospitalized COVID-19 patients were enrolled in this study. The median age was 74.5 years (IQR 64 - 82) and 59% were male. Hypertension (76%) and diabetes mellitus (56%) were common. At the first KRT prescription, 85% of the patients were on invasive mechanical ventilation and 71% were using vasoactive drugs. Continuous veno-venous hemodiafiltration (CVVHDF) was the preferred KRT modality (82%). CFR was 93% and 81 out of 93 deaths (87%) occurred within the first 10 days of KRT onset.
Conclusion: AKRT in hospitalized COVID-19 patients resulted in a CFR of 93%. Patients treated with AKRT were typically older, critically ill, and most died within 10 days of diagnosis. Better strategies to address this issue are urgently needed.
{"title":"Case fatality rate among COVID-19 patients treated with acute kidney replacement therapy.","authors":"Gabriel Martins Nogueira, Paulo Novis Rocha, Constança Margarida Sampaio Cruz","doi":"10.1590/2175-8239-JBN-2022-0161en","DOIUrl":"10.1590/2175-8239-JBN-2022-0161en","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) is a frequent complication of severe COVID-19 and is associated with high case fatality rate (CFR). However, there is scarcity of data referring to the CFR of AKI patients that underwent kidney replacement therapy (KRT) in Brazil. The main objective of this study was to describe the CFR of critically ill COVID-19 patients treated with acute kidney replacement therapy (AKRT).</p><p><strong>Methods: </strong>Retrospective descriptive cohort study. We included all patients treated with AKRT at an intensive care unit in a single tertiary hospital over a 15-month period. We excluded patients under the age of 18 years, patients with chronic kidney disease on maintenance dialysis, and cases in which AKI preceded COVID-19 infection.</p><p><strong>Results: </strong>A total of 100 out of 1479 (6.7%) hospitalized COVID-19 patients were enrolled in this study. The median age was 74.5 years (IQR 64 - 82) and 59% were male. Hypertension (76%) and diabetes mellitus (56%) were common. At the first KRT prescription, 85% of the patients were on invasive mechanical ventilation and 71% were using vasoactive drugs. Continuous veno-venous hemodiafiltration (CVVHDF) was the preferred KRT modality (82%). CFR was 93% and 81 out of 93 deaths (87%) occurred within the first 10 days of KRT onset.</p><p><strong>Conclusion: </strong>AKRT in hospitalized COVID-19 patients resulted in a CFR of 93%. Patients treated with AKRT were typically older, critically ill, and most died within 10 days of diagnosis. Better strategies to address this issue are urgently needed.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89718335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1590/2175-8239-JBN-2023-0160en
Filipa Ferreira, Núria Paulo, Altin Ndrio
{"title":"Crystals unveiled: looking at urine can be quite useful.","authors":"Filipa Ferreira, Núria Paulo, Altin Ndrio","doi":"10.1590/2175-8239-JBN-2023-0160en","DOIUrl":"10.1590/2175-8239-JBN-2023-0160en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140012581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1590/2175-8239-JBN-2022-0158en
Cassio Rodrigues Ferrari, Carlos Eduardo Lopes, Vera Maria Santoro Belangero
Introduction: Acute Kidney Injury (AKI) in the Intensive Care Unit (ICU) have concepts of diagnosis and management have water balance as their main point of evaluation. In our ICU, from 2004 to 2012, the nephrologist's participation was on demand only; and as of 2013 their participation became continuous in meetings to case discussion. The aim of this study was to establish how an intense nephrologist/intensivist interaction influenced the frequency of dialysis indication, fluid balance and pRIFLE classification during these two observation periods.
Methods: Retrospective study, longitudinal evaluation of all children with AKI undergoing dialysis (2004 to 2016).
Parameters studied: frequency of indication, duration and volume of infusion in the 24 hours preceding dialysis; diuresis and water balance every 8 hours. Non-parametric statistics, p ≤ 0.05.
Results: 53 patients (47 before and 6 after 2013). There were no significant differences in the number of hospitalizations or cardiac surgeries between the periods. After 2013, there was a significant decrease in the number of indications for dialysis/year (5.85 vs. 1.5; p = 0.000); infusion volume (p = 0.02), increase in the duration of dialysis (p = 0.002) and improvement in the discrimination of the pRIFLE diuresis component in the AKI development.
Conclusion: Integration between the ICU and pediatric nephrology teams in the routine discussion of cases, critically approaching water balance, was decisive to improve the management of AKI in the ICU.
导言:重症监护病房(ICU)中的急性肾损伤(AKI)诊断和管理概念以水平衡为评估要点。在我们的重症监护病房,从 2004 年到 2012 年,肾脏科医生的参与都是按需进行的;从 2013 年开始,他们开始持续参与病例讨论会议。本研究旨在确定在这两个观察期内,肾内科医师与重症监护医师之间的密切互动如何影响透析指征、体液平衡和 pRIFLE 分类的频率:研究参数:透析前24小时内的适应症频率、持续时间和输液量;每8小时的利尿和水平衡。非参数统计,P≤0.05.结果:53名患者(2013年前47名,2013年后6名)。不同时期的住院或心脏手术次数无明显差异。2013年后,透析指征/年数量明显减少(5.85 vs. 1.5;p = 0.000);输液量明显减少(p = 0.02);透析持续时间明显延长(p = 0.002);在AKI发展过程中,pRIFLE利尿成分的辨别能力有所提高:结论:重症监护室和儿科肾脏内科团队在病例的常规讨论中进行整合,重点关注水平衡,这对改善重症监护室的 AKI 管理至关重要。
{"title":"Pediatric nephrologist-intensivist interaction in acute kidney injury.","authors":"Cassio Rodrigues Ferrari, Carlos Eduardo Lopes, Vera Maria Santoro Belangero","doi":"10.1590/2175-8239-JBN-2022-0158en","DOIUrl":"10.1590/2175-8239-JBN-2022-0158en","url":null,"abstract":"<p><strong>Introduction: </strong>Acute Kidney Injury (AKI) in the Intensive Care Unit (ICU) have concepts of diagnosis and management have water balance as their main point of evaluation. In our ICU, from 2004 to 2012, the nephrologist's participation was on demand only; and as of 2013 their participation became continuous in meetings to case discussion. The aim of this study was to establish how an intense nephrologist/intensivist interaction influenced the frequency of dialysis indication, fluid balance and pRIFLE classification during these two observation periods.</p><p><strong>Methods: </strong>Retrospective study, longitudinal evaluation of all children with AKI undergoing dialysis (2004 to 2016).</p><p><strong>Parameters studied: </strong>frequency of indication, duration and volume of infusion in the 24 hours preceding dialysis; diuresis and water balance every 8 hours. Non-parametric statistics, p ≤ 0.05.</p><p><strong>Results: </strong>53 patients (47 before and 6 after 2013). There were no significant differences in the number of hospitalizations or cardiac surgeries between the periods. After 2013, there was a significant decrease in the number of indications for dialysis/year (5.85 vs. 1.5; p = 0.000); infusion volume (p = 0.02), increase in the duration of dialysis (p = 0.002) and improvement in the discrimination of the pRIFLE diuresis component in the AKI development.</p><p><strong>Conclusion: </strong>Integration between the ICU and pediatric nephrology teams in the routine discussion of cases, critically approaching water balance, was decisive to improve the management of AKI in the ICU.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9414770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1590/2175-8239-JBN-2023-0017en
Fabiana Baggio Nerbass, Aline de Araujo Antunes, Lilian Cuppari
Introduction: In 2004, the Ministry of Health stipulated that dialysis centers were required to have at least one dietitian on their staff. However, the regulation did not include recommendations regarding the number of dietitians or the workload based on the number of patients assisted.
Objective: To describe the demographic and occupational profiles of dietitians working in dialysis centers in Brazil.
Methodology: An electronic questionnaire was disseminated in social media and messaging apps with questions about the demographic and occupational profile of dietitians working in dialysis centers and matters related to patient care.
Results: A total of 207 questionnaires were answered, covering 24% of the dialysis centers in Brazil. More than half of the dietitians (58%) had worked for more than five years in dialysis centers, and 83% reported additional training in Nephrology. The median (interquartile range) number of patients per monthly working hour was 1.6 (1.0-2.3). Considering all dialysis centers, 64% of the patients were seen at least once a month. Differences in demographic/occupational profiles and patient care were associated with workload, the main source of dialysis funding, and Brazilian geographical region.
Conclusion: Most dietitians were experienced and trained in Nephrology. Substantial variability was found in the number of patients per dietitian workload, and proportion of patients receiving monthly nutritional care. Further studies are needed to discuss the demands of dietitians, dialysis centers, and patients.
{"title":"Demographic and occupational profile of dietitians working in dialysis centers in Brazil.","authors":"Fabiana Baggio Nerbass, Aline de Araujo Antunes, Lilian Cuppari","doi":"10.1590/2175-8239-JBN-2023-0017en","DOIUrl":"10.1590/2175-8239-JBN-2023-0017en","url":null,"abstract":"<p><strong>Introduction: </strong>In 2004, the Ministry of Health stipulated that dialysis centers were required to have at least one dietitian on their staff. However, the regulation did not include recommendations regarding the number of dietitians or the workload based on the number of patients assisted.</p><p><strong>Objective: </strong>To describe the demographic and occupational profiles of dietitians working in dialysis centers in Brazil.</p><p><strong>Methodology: </strong>An electronic questionnaire was disseminated in social media and messaging apps with questions about the demographic and occupational profile of dietitians working in dialysis centers and matters related to patient care.</p><p><strong>Results: </strong>A total of 207 questionnaires were answered, covering 24% of the dialysis centers in Brazil. More than half of the dietitians (58%) had worked for more than five years in dialysis centers, and 83% reported additional training in Nephrology. The median (interquartile range) number of patients per monthly working hour was 1.6 (1.0-2.3). Considering all dialysis centers, 64% of the patients were seen at least once a month. Differences in demographic/occupational profiles and patient care were associated with workload, the main source of dialysis funding, and Brazilian geographical region.</p><p><strong>Conclusion: </strong>Most dietitians were experienced and trained in Nephrology. Substantial variability was found in the number of patients per dietitian workload, and proportion of patients receiving monthly nutritional care. Further studies are needed to discuss the demands of dietitians, dialysis centers, and patients.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9959861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1590/2175-8239-JBN-2022-0124en
Francini Porcher Andrade, Carolina Ferraro Borba, Heitor Siqueira Ribeiro, Paula Maria Eidt Rovedder
Background: Kidney failure reduces life expectancy by one-third compared with the general population, and cardiovascular complications and poor cardiorespiratory fitness (CRF) are the main causes. We aimed to evaluate the association between severely low CRF and all-cause mortality risk in HD patients.
Methods: This observational prospective cohort study followed-up patients receiving HD from August 2015 until March 2022. Cardiorespiratory fitness was evaluated through the cardiopulmonary exercise test, and the peak oxygen uptake (VO2peak) value was used to determine severely low CRF (< 15 mL∙kg-1∙min-1). Cox regression and univariate Kaplan-Meier analysis were used to evaluate the association of severely low CRF with mortality risk and survival rate.
Results: Forty-eight patients were followed-up for a median of 33.0 [14.3 - 49.3] months. A total of 26 patients had severely low CRF. During the follow-up period, 11 patients (22.92%) died from all causes. From these, eight (30.8%) had severely low CRF. Even so, severely low CRF was not associated with crude death rates for patients stratified by CRF levels (p = 0.189), neither in unadjusted (HR 2.18; CI 95% 0.58-8.23) nor in adjusted (HR 1.32; CI 95% 0.31-5.59) Cox proportional hazard models. As a continuous variable, VO2peak was not associated with mortality risk (HR 1.01; CI 95% 0.84-1.21). Univariate Kaplan-Meier analysis showed that patients with severely low CRF did not have significantly worse survival rates than those with mild-moderate CRF (p = 0.186).
Conclusion: Our findings indicated that severely low CRF was not associated with all-cause mortality in patients on HD. Despite severely low CRF being prevalent, larger cohort studies are needed to establish strong conclusions on its association with all-cause mortality.
{"title":"Cardiorespiratory fitness and mortality risk in patients receiving hemodialysis: a prospective cohort.","authors":"Francini Porcher Andrade, Carolina Ferraro Borba, Heitor Siqueira Ribeiro, Paula Maria Eidt Rovedder","doi":"10.1590/2175-8239-JBN-2022-0124en","DOIUrl":"10.1590/2175-8239-JBN-2022-0124en","url":null,"abstract":"<p><strong>Background: </strong>Kidney failure reduces life expectancy by one-third compared with the general population, and cardiovascular complications and poor cardiorespiratory fitness (CRF) are the main causes. We aimed to evaluate the association between severely low CRF and all-cause mortality risk in HD patients.</p><p><strong>Methods: </strong>This observational prospective cohort study followed-up patients receiving HD from August 2015 until March 2022. Cardiorespiratory fitness was evaluated through the cardiopulmonary exercise test, and the peak oxygen uptake (VO2peak) value was used to determine severely low CRF (< 15 mL∙kg-1∙min-1). Cox regression and univariate Kaplan-Meier analysis were used to evaluate the association of severely low CRF with mortality risk and survival rate.</p><p><strong>Results: </strong>Forty-eight patients were followed-up for a median of 33.0 [14.3 - 49.3] months. A total of 26 patients had severely low CRF. During the follow-up period, 11 patients (22.92%) died from all causes. From these, eight (30.8%) had severely low CRF. Even so, severely low CRF was not associated with crude death rates for patients stratified by CRF levels (p = 0.189), neither in unadjusted (HR 2.18; CI 95% 0.58-8.23) nor in adjusted (HR 1.32; CI 95% 0.31-5.59) Cox proportional hazard models. As a continuous variable, VO2peak was not associated with mortality risk (HR 1.01; CI 95% 0.84-1.21). Univariate Kaplan-Meier analysis showed that patients with severely low CRF did not have significantly worse survival rates than those with mild-moderate CRF (p = 0.186).</p><p><strong>Conclusion: </strong>Our findings indicated that severely low CRF was not associated with all-cause mortality in patients on HD. Despite severely low CRF being prevalent, larger cohort studies are needed to establish strong conclusions on its association with all-cause mortality.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9879761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1590/2175-8239-JBN-2022-0132en
Lisianara Acosta Ramos, Tiago Schiavo, Juliana Montagner, Cristiane Bundcher, Roger Kist, Valter Duro Garcia, Jorge Neumann, Elizete Keitel
Introduction: The aim of this study was to analyze the waiting list for kidney transplantation in our hospital according to candidate's panel reactive antibodies (cPRA) and its outcomes.
Methods: One thousand six hundred forty patients who were on the waiting list between 2015 and 2019 were included. For the analysis, hazard ratios (HR) for transplant were estimated by Fine and Gray's regression model according to panel reactivity and HR for graft loss and death after transplantation.
Results: The mean age was 45.39 ± 18.22 years. Male gender was predominant (61.2%), but the proportion decreased linearly with the increase in cPRA (p < 0.001). The distribution of patients according to panels were: 0% (n = 390), 1% - 49% (n = 517), 50% - 84% (n = 269), and ≥ 85% (n = 226). Transplantation was achieved in 85.5% of the sample within a median time of 8 months (CI 95%: 6.9 - 9.1). The estimated HRs for transplantation during the follow-up were 2.84 (95% CI: 2.51 - 3.34), 2.41(95%CI: 2.07 - 2.80), and 2.45(95%CI: 2.08 - 2.90) in the cPRA range of 0%, 1%-49%, and 50%-84%, respectively, compared to cPRA ≥ 85 (p < 0.001). After transplantation, the HR for graft loss was similar in the different cPRA groups, but the HR for death (0.46 95% CI 0.24-0.89 p = 0.022) was lower in the 0% cPRA group when adjusted for age, gender, and presence of donor specific antibodies (DSA).
Conclusion: Patients with cPRA below 85% are more than twice as likely to receive a kidney transplantation with a shorter waiting time. The risk of graft loss after transplantation was similar in the different cPRA groups, and the adjusted risk of death was lower in nonsensitized recipients.
{"title":"Waiting time for kidney transplantation based on calculated panel reactive antibodies: experience of a southern Brazilian center.","authors":"Lisianara Acosta Ramos, Tiago Schiavo, Juliana Montagner, Cristiane Bundcher, Roger Kist, Valter Duro Garcia, Jorge Neumann, Elizete Keitel","doi":"10.1590/2175-8239-JBN-2022-0132en","DOIUrl":"10.1590/2175-8239-JBN-2022-0132en","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to analyze the waiting list for kidney transplantation in our hospital according to candidate's panel reactive antibodies (cPRA) and its outcomes.</p><p><strong>Methods: </strong>One thousand six hundred forty patients who were on the waiting list between 2015 and 2019 were included. For the analysis, hazard ratios (HR) for transplant were estimated by Fine and Gray's regression model according to panel reactivity and HR for graft loss and death after transplantation.</p><p><strong>Results: </strong>The mean age was 45.39 ± 18.22 years. Male gender was predominant (61.2%), but the proportion decreased linearly with the increase in cPRA (p < 0.001). The distribution of patients according to panels were: 0% (n = 390), 1% - 49% (n = 517), 50% - 84% (n = 269), and ≥ 85% (n = 226). Transplantation was achieved in 85.5% of the sample within a median time of 8 months (CI 95%: 6.9 - 9.1). The estimated HRs for transplantation during the follow-up were 2.84 (95% CI: 2.51 - 3.34), 2.41(95%CI: 2.07 - 2.80), and 2.45(95%CI: 2.08 - 2.90) in the cPRA range of 0%, 1%-49%, and 50%-84%, respectively, compared to cPRA ≥ 85 (p < 0.001). After transplantation, the HR for graft loss was similar in the different cPRA groups, but the HR for death (0.46 95% CI 0.24-0.89 p = 0.022) was lower in the 0% cPRA group when adjusted for age, gender, and presence of donor specific antibodies (DSA).</p><p><strong>Conclusion: </strong>Patients with cPRA below 85% are more than twice as likely to receive a kidney transplantation with a shorter waiting time. The risk of graft loss after transplantation was similar in the different cPRA groups, and the adjusted risk of death was lower in nonsensitized recipients.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41178923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Living donor kidney transplantation is considered the ideal renal replacement therapy because it has a lower complication rate and allows an efficient response to the high demand for grafts in the healthcare system. Careful selection and adequate monitoring of donors is a key element in transplantation. Individuals at greater risk of developing kidney dysfunction after nephrectomy must be identified.
Objective: To identify risk factors associated with a renal compensation rate (CR) below 70% 12 months after nephrectomy.
Methods: This observational retrospective longitudinal study included living kidney donors followed up at the Lower Amazon Regional Hospital between 2016 and 2022. Data related to sociodemographic variables, comorbid conditions and kidney function parameters were collected.
Results: The study enrolled 32 patients. Fourteen (43.75%) had a CR < 70% 12 months after kidney donation. Logistic regression found obesity (Odds Ratio [95%CI]: 10.6 [1.7-65.2]), albuminuria (Odds Ratio [95%CI]: 2.41 [1.2-4.84]) and proteinuria (Odds Ratio [95%CI]: 1.14 [1.03-1.25]) as risk factors. Glomerular filtration rate was a protective factor (Odds Ratio [95% CI]: 0.92 [0.85-0.99]).
Conclusion: Obesity, albuminuria and proteinuria adversely affected short-term renal compensation rate. Further studies are needed to uncover the prognostic implications tied to these risk factors. Our findings also supported the need for careful individualized assessment of potential donors and closer monitoring of individuals at higher risk.
简介活体肾移植被认为是最理想的肾脏替代疗法,因为它的并发症发生率较低,并能有效满足医疗系统对移植肾的大量需求。谨慎选择和充分监测供体是移植的关键因素。必须识别肾切除术后出现肾功能障碍风险较大的个体:确定肾切除术后 12 个月肾代偿率 (CR) 低于 70% 的相关风险因素:这项观察性回顾纵向研究纳入了2016年至2022年期间在亚马逊河下游地区医院随访的活体肾脏捐献者。研究收集了与社会人口学变量、合并症和肾功能参数相关的数据:研究共纳入 32 名患者。14人(43.75%)在肾脏捐献12个月后CR<70%。逻辑回归发现肥胖(Odds Ratio [95%CI]:10.6 [1.7-65.2])、白蛋白尿(Odds Ratio [95%CI]:2.41 [1.2-4.84])和蛋白尿(Odds Ratio [95%CI]:1.14 [1.03-1.25])是风险因素。肾小球滤过率是一个保护性因素(Odds Ratio [95%CI]: 0.92 [0.85-0.99]):结论:肥胖、白蛋白尿和蛋白尿对短期肾脏代偿率有不利影响。结论:肥胖、白蛋白尿和蛋白尿对短期肾脏代偿率有不利影响,需要进一步研究以揭示这些风险因素对预后的影响。我们的研究结果还表明,有必要对潜在捐献者进行仔细的个体化评估,并对高风险人群进行更密切的监测。
{"title":"Risk factors for lower renal compensation after nephrectomy: an analysis of living kidney donors in an Amazonian cohort.","authors":"Luan Moraes Ferreira, Gisela Gomes Batista, Leoneide Érica Maduro Bouillet, Emanuel Pinheiro Esposito","doi":"10.1590/2175-8239-JBN-2023-0134en","DOIUrl":"10.1590/2175-8239-JBN-2023-0134en","url":null,"abstract":"<p><strong>Introduction: </strong>Living donor kidney transplantation is considered the ideal renal replacement therapy because it has a lower complication rate and allows an efficient response to the high demand for grafts in the healthcare system. Careful selection and adequate monitoring of donors is a key element in transplantation. Individuals at greater risk of developing kidney dysfunction after nephrectomy must be identified.</p><p><strong>Objective: </strong>To identify risk factors associated with a renal compensation rate (CR) below 70% 12 months after nephrectomy.</p><p><strong>Methods: </strong>This observational retrospective longitudinal study included living kidney donors followed up at the Lower Amazon Regional Hospital between 2016 and 2022. Data related to sociodemographic variables, comorbid conditions and kidney function parameters were collected.</p><p><strong>Results: </strong>The study enrolled 32 patients. Fourteen (43.75%) had a CR < 70% 12 months after kidney donation. Logistic regression found obesity (Odds Ratio [95%CI]: 10.6 [1.7-65.2]), albuminuria (Odds Ratio [95%CI]: 2.41 [1.2-4.84]) and proteinuria (Odds Ratio [95%CI]: 1.14 [1.03-1.25]) as risk factors. Glomerular filtration rate was a protective factor (Odds Ratio [95% CI]: 0.92 [0.85-0.99]).</p><p><strong>Conclusion: </strong>Obesity, albuminuria and proteinuria adversely affected short-term renal compensation rate. Further studies are needed to uncover the prognostic implications tied to these risk factors. Our findings also supported the need for careful individualized assessment of potential donors and closer monitoring of individuals at higher risk.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1590/2175-8239-JBN-2023-E013en
Maria Cristina de Andrade, Nilzete Liberato Bresolin, Ana Paula Brecheret
{"title":"Low birth weight and renal consequences: knowing about it means preventing it.","authors":"Maria Cristina de Andrade, Nilzete Liberato Bresolin, Ana Paula Brecheret","doi":"10.1590/2175-8239-JBN-2023-E013en","DOIUrl":"10.1590/2175-8239-JBN-2023-E013en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138803722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}