Cross-cultural validation of the Portuguese version of the Dialysis Symptom Index for haemodialysis patients.

Background: Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) are associated with low quality of life (QoL) and high disease-related symptoms. The patient self-report instruments can assess the burden of physical and psychological symptoms. The Dialysis Symptom Index (DSI) is a specific instrument to evaluate the multidimensional reported symptoms by patients undergoing HD. Aims: To translate, validate and assess the psychometric properties of the Portuguese version of the DSI. Methods: A cross-cultural adaptation process from English to Portuguese and a validation study (n = 156) were conducted. Reliability, validity and responsiveness were assessed. Results: The patients' most reported symptoms were, nausea (n = 86, 55%), muscle cramps (n = 92, 59%), feeling tired or lack of energy (n = 92, 59%), bone or joint pain (n = 88, 56%) and trouble staying asleep (n = 95, 60%). Cronbach's alpha of the DSI was 0.87, and intraclass correlation coefficient was 0.868 (95%CI 0.836-0.896). The smallest detectable change was 28.32. Conclusion: The Portuguese DSI demonstrates excellent psychometric properties for assessing HD patients' reported symptoms. It highlights symptom severity and impact, providing valuable insights for healthcare practitioners. Nurses can use the DSI to tailor interventions and enhance patient-centred care.

Cross-cultural validation of the Short-Form Vascular Access Questionnaire.

BACKGROUND: Vascular access (VA) is a central condition for hemodialysis (HD). Screening patients' views regarding their VA is a significant end point for improving the quality of care. The Short-form Vascular Access Questionnaire (SF-VAQ) is a specific questionnaire to assess patients' satisfaction levels regarding their VA. PURPOSE: This study aims to develop the Portuguese version of the SF-VAQ and assess its psychometric properties. METHODS: A forward and back translation was used. A multicentric study was conducted with 156 patients undergoing hemodialysis to psychometric testing. Reliability (internal consistency and test-retest) was assessed using Cronbach's alpha and Intraclass Correlation Coefficient. A construct validity test was conducted using factor analysis. The convergent validity was calculated using the correlation coefficient. RESULTS: An obtained Cronbach's alpha of 0.77 indicates good internal consistency. The test-retest reliability was established using the Intraclass Correlation Coefficient (ICC) of 0.771. The four sub-scales proposed by the instrument's designer were confirmed, which together accounted for 53% of the variance. The correlation with the Visual Analogue Scale was r = 0.895 (p < 0.001), confirming the convergent validity. CONCLUSION: The Portuguese version of the SF-VAQ is a valid and reliable instrument with good psychometric properties to be implemented to promote an evaluation of VA satisfaction in HD patients and improve patient care.

The type of SARS-CoV-2 vaccine influences serological response in kidney transplant recipients.

Vaccination is a promising strategy to control the ongoing pandemic; however, solid organ recipients tend to develop a weaker immune response to vaccination. Anti-spike SARS-CoV-2 antibodies titers were measured 2-4 weeks post-vaccination completion in 131 KT patients without previous infection. Demographic, clinical, and laboratorial parameters were analyzed to identify which factors contributed to seroconversion. Factors that influenced seroconversion, that occurred in 76 patients (58%), were longer time post-transplant, immunosuppression without an antiproliferative drug and vaccination with mRNA vaccines. Patients who received mRNA vaccines had significantly higher rates of seroconversion compared with adenovirus vector vaccines (67% vs 33%, P < .001) and higher anti-spike IgG titers. These findings reinforce the need to discuss the vaccination strategy in this population, including a third dose with a mRNA vaccine.

Membranoproliferative glomerulonephritis in a puerperal with Sjögren's syndrome: Rare finding or something else? / Glomerulonefritis membranoproliferativa en una puerpéra con síndrome de Sjögren: hallazgo raro o algo más?

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Severe acute kidney injury and multiple myeloma: evaluation of kidney and patient prognostic factors.

BACKGROUND: Patients with multiple myeloma (MM) manifesting acute kidney injury (AKI) and who later recover renal function and independence from renal replacement therapy (RRT) are considered to have a better outcome. The aim of this work was to study the factors associated with renal function recovery (independence of hemodialysis) and longer survival in these patients. METHODS: A retrospective single center study including patients with a diagnosis of MM and severe AKI, defined as stage 3 of the Kidney Disease: Improving Global Outcomes (KDIGO) criteria: 3.0 times baseline increase in serum creatinine (sCr) or increase in sCr to ≥4.0mg/dL or initiation of RRT, was conducted. Data was registry-based and collected between January 2000 and December 2011. We examined demographic and laboratorial data, presenting clinical features, precipitating factors, need for RRT and chemotherapy. Death was considered the primary endpoint. RESULTS: Lower serum ß2-microglobulin was the only independent factor associated with recovery of renal function and independence of RRT (OR 0.95, 95% CI: 0.91-0.99, P=0.02). The median survival after AKI was 10.7±12.1months. The factors associated with longer survival were independence of RRT (HR 2.21; 95% CI: 1.08-4.49; P=0.02), lower CRP (HR 1.07; 95% CI: 1.03-1.12; P=0.001) and younger age (HR 1.03; 95% CI: 1.01-1.06; P=0.005). CONCLUSIONS: Our study suggests that MM patients with lower serum ß2-microglobulin have a higher likelihood of recovering renal function after severe AKI. Independence of RRT, lower CRP and younger age are associated with longer survival.

Hypouricaemia and hyperuricosuria in familial renal glucosuria.

Familial renal glucosuria is a rare co-dominantly inherited benign phenotype characterized by the presence of glucose in the urine. It is caused by mutations in the SLC5A2 gene that encodes SGLT2, the Na(+)-glucose cotransporter responsible for the reabsorption of the bulk of glucose in the proximal tubule. We report a case of FRG displaying both severe glucosuria and renal hypouricaemia. We hypothesize that glucosuria can disrupt urate reabsorption in the proximal tubule, directly causing hyperuricosuria.