Incremento del riesgo hemorrágico en pacientes con fibrilación auricular y enfermedad renal crónica en hemodiálisis tratados con anticoagulantes. Serie de cuatro centros / Increased risk of bleeding in patients with atrial fibrillation and chronic kidney disease on hemodialysis treated with anticoagulants. A four center series

Resumen Objetivo: El objetivo de este estudio fue estimar si el uso de anticoagulantes se asociaba con una diferencia en la frecuencia de trombosis de cualquier sitio, hemorragia mayor y mortalidad en adultos con coexistencia de ambas patologías. Método: Se realizó un estudio de cohorte retrospectivo en cuatro centros de alta complejidad. Se incluyeron mayores de 18 años con ERC en hemodiálisis y FA no valvular, con indicación de anticoagulación (CHA2DS2VASc ≥ 2). El desenlace primario fue la ocurrencia de sangrado mayor, evento trombótico (accidente vascular cerebral, infarto agudo al miocardio o enfermedad tromboembólica venosa) o muerte. Se realizó ajuste por variables de confusión por regresión logística. Resultados: De los 158 pacientes incluidos, el 61% (n = 97) recibieron anticoagulante. El desenlace principal se encontró en el 84% de quienes recibieron anticoagulación y en el 70% de quienes no la recibieron (OR: 2.12, IC95%: 0.98-4.57; luego del ajuste OR: 2.13, IC95%: 1.04-4.36). De los desenlaces mayores se presentaron sangrado en el 52% vs. el 34% (OR: 2.03; IC95%: 1.05-3.93), trombosis en el 35% vs. el 34% (OR: 1.03; IC95%: 0.52-2.01) y muerte en el 46% vs. el 41% (OR: 1.25; IC95%: 0.65-2.38). Conclusiones: Los resultados de este estudio sugieren un incremento en el riesgo de sangrado en los pacientes con FA y ERC en hemodiálisis que reciben anticoagulación, sin disminución del riesgo de eventos trombóticos ni de muerte.

Abstract Objective: The aim of this study was to estimate whether the consumption of anticoagulants was associated with a difference in the frequency of thrombosis of any site, major bleeding and mortality, in adults with both diseases. Method: A retrospective cohort study was carried out in four high complexity centers. Patients older than 18 years with CKD on hemodialysis and non-valvular AF, with an indication for anticoagulation (CHA2DS2VASc ≥ 2), were included. The primary outcome was the occurrence of: major bleeding, thrombotic event (cerebrovascular accident, acute myocardial infarction or venous thromboembolic disease) or death. Adjustment for confounding variables was performed using logistic regression. Results: From 158 patients included, 61% (n = 97) received an anticoagulant. The main outcome was found in 84% of those who received anticoagulation and 70% of those who did not (OR: 2.12, 95%CI: 0.98-4.57; after the adjusted analysis OR: 2.13, 95%CI: 1.04-4.36). Separate outcomes were bleeding in 52% vs. 34% (OR: 2.03; 95%CI: 1.05-3.93), thrombosis in 35% vs. 34% (OR: 1.03; 95%CI: 0.52-2-01) and death in 46% vs. 41% (OR: 1.25; 95%CI: 0.65-2.38). Conclusions: The results of this study suggest an increased risk of bleeding in patients with AF and CKD on hemodialysis receiving anticoagulation, without a decrease in the risk of thrombotic events or all-cause mortality.

Sudan's healthcare crisis: The struggle of kidney patients amidst conflict.

Background and Aim: Conflicts, akin to other crises, disrupt lives and healthcare infrastructure, disproportionately affecting vulnerable individuals. The ongoing Sudanese conflict, initiated on April 15, 2023, between the Sudanese Armed Forces (SAF) and the Rapid Support Force (RSF), triggers significant population displacement, healthcare facility closures, and a scarcity of medical resources. Amid the intense conflict in Khartoum, reports of deceased individuals in the streets heighten concerns about public health, emphasizing the gravity of the situation. This crisis compounds the challenges faced by Sudan's already fragile healthcare system, impacting over 5 million displaced individuals, including those reliant on life-saving hemodialysis sessions. This commentary aims to illuminate the challenges confronting kidney dialysis patients in war-torn Sudan, emphasizing the impact on the Al-Goled hemodialysis center. Methodology: This commentary relies on reports from the American Society of Nephrology (ASN), European Renal Association (ERA), and The International Society of Nephrology (ISN), along with recent journal articles discussing the consequences of ongoing conflicts. Personal observations in Al-Goled contribute to the insights, and data from the Al-Goled hemodialysis center in Sudan illuminate the struggles faced by kidney dialysis patients during the conflict, presented as a case study. Results: Kidney dialysis patients, crucial for regular hemodialysis sessions, confront severe challenges due to the overwhelming conflict. With an estimated 8000 kidney failure patients in Sudan, disruptions in healthcare services, targeted attacks on medical staff, and a shortage of resources exacerbate their plight. The Al-Goled hemodialysis center, initially designed for 30 daily sessions, experiences a surge in demand, accommodating 85 patients daily-an alarming 183% increase. Limited resources, machine malfunctions, and a shortage of medications contribute to the loss of 13 patients' lives. Conclusions: The conflict in Sudan disproportionately impacts kidney dialysis patients, causing disruptions in essential healthcare services. The surge in demand at the Al-Goled center underscores the broader impact on healthcare institutions nationwide. Local efforts to source medical supplies face bureaucratic hurdles and complex exportation procedures, impeding support for kidney patients. Patients, once receiving 3 weekly sessions, now struggle to secure even one, jeopardizing their well-being. Urgent international intervention is needed to cease the conflict and ensure the safety of healthcare facilities, especially for vulnerable populations like kidney dialysis patients.

[Increased risk of bleeding in patients with atrial fibrillation and chronic kidney disease on hemodialysis treated with anticoagulants. A four center serie]. / Incremento del riesgo hemorrágico en pacientes con fibrilación auricular y enfermedad renal crónica en hemodiálisis tratados con anticoagulantes. Serie de cuatro centros.

Background: Because the benefits and risks of anticoagulation are still unknown in patients with atrial fibrillation (AF) and with chronic kidney disease (CKD) on hemodialysis. Objective: The aim of this study was to estimate whether the consumption of anticoagulants was associated with a difference in the frequency of thrombosis of any site, major bleeding and mortality, in adults with both diseases. Method: A retrospective cohort study was carried out in four high complexity centers. Patients older than 18 years with CKD on hemodialysis and non-valvular AF, with an indication for anticoagulation (CHA2DS-2VASc ≥ 2), were included. The primary outcome was the occurrence of: major bleeding, thrombotic event (cerebrovascular accident, acute myocardial infarction or venous thromboembolic disease) or death. Adjustment for confounding variables was performed using logistic regression. Results: From 158 patients included, 61% (n = 97) received an anticoagulant. The main outcome was found in 84% of those who received anticoagulation and 70% of those who did not (OR: 2.12, 95%CI: 0.98-4.57; after the adjusted analysis OR: 2.13, 95%CI: 1.04-4.36). Separate outcomes were bleeding in 52% vs. 34% (OR: 2.03; 95%CI: 1.05-3.93), thrombosis in 35% vs. 34% (OR: 1.03; 95%CI: 0.52-2-01) and death in 46% vs 41% (OR: 1.25; 95%CI: 0.65-2.38). Conclusions: The results of this study suggest an increased risk of bleeding in patients with AF and CKD on hemodialysis receiving anticoagulation, without a decrease in the risk of thrombotic events or all-cause mortality.

Antecedentes: Puesto que se desconocen el beneficio y los riesgos de la anticoagulación en pacientes con fibrilación auricular (FA) y enfermedad renal crónica (ERC) terminal en hemodiálisis. Objetivo: El objetivo de este estudio fue estimar si el uso de anticoagulantes se asociaba con una diferencia en la frecuencia de trombosis de cualquier sitio, hemorragia mayor y mortalidad en adultos con coexistencia de ambas patologías. Método: Se realizó un estudio de cohorte retrospectivo en cuatro centros de alta complejidad. Se incluyeron mayores de 18 años con ERC en hemodiálisis y FA no valvular, con indicación de anticoagulación (CHA2DS2VASc ≥ 2). El desenlace primario fue la ocurrencia de sangrado mayor, evento trombótico (accidente vascular cerebral, infarto agudo al miocardio o enfermedad tromboembólica venosa) o muerte. Se realizó ajuste por variables de confusión por regresión logística. Resultados: De los 158 pacientes incluidos, el 61% (n = 97) recibieron anticoagulante. El desenlace principal se encontró en el 84% de quienes recibieron anticoagulación y en el 70% de quienes no la recibieron (OR: 2.12, IC95%: 0.98-4.57; luego del ajuste OR: 2.13, IC95%: 1.04-4.36). De los desenlaces mayores se presentaron sangrado en el 52% vs. el 34% (OR: 2.03; IC95%: 1.05-3.93), trombosis en el 35% vs. el 34% (OR: 1.03; IC95%: 0.52-2.01) y muerte en el 46% vs. el 41% (OR: 1.25; IC95%: 0.65-2.38). Conclusiones: Los resultados de este estudio sugieren un incremento en el riesgo de sangrado en los pacientes con FA y ERC en hemodiálisis que reciben anticoagulación, sin disminución del riesgo de eventos trombóticos ni de muerte.

Guidelines on vascular access for hemodialysis from the Brazilian Society of Angiology and Vascular Surgery.

Chronic kidney disease is a worldwide public health problem, and end-stage renal disease requires dialysis. Most patients requiring renal replacement therapy have to undergo hemodialysis. Therefore, vascular access is extremely important for the dialysis population, directly affecting the quality of life and the morbidity and mortality of this patient population. Since making, managing and salvaging of vascular accesses falls within the purview of the vascular surgeon, developing guideline to help specialists better manage vascular accesses for hemodialysis if of great importance. Thus, the objective of this guideline is to present a set of recommendations to guide decisions involved in the referral, evaluation, choice, surveillance and management of complications of vascular accesses for hemodialysis.

A doença renal crônica é um problema de saúde pública global e em seu estágio terminal está associada à necessidade de terapia dialítica. A grande maioria dos pacientes que necessitam realizar a terapia renal substitutiva, a fazem através da hemodiálise. Portanto, o acesso vascular é de extrema importância para a população dialítica, implicando diretamente na qualidade de vida e na morbimortalidade deste grupo de pacientes. Sendo a confecção, gerenciamento e resgate dos acessos vasculares uma das áreas de atuação do cirurgião vascular, é de grande importância a elaboração de uma diretriz que oriente o especialista no manejo mais adequado do acesso vascular para hemodiálise. Assim, o objetivo desta diretriz é apresentar um conjunto de recomendações para guiar as decisões na referenciação, avaliação, escolha, vigilância e gestão das complicações do acesso vascular para hemodiálise.

Clinical efficacy of the fourth dose of the BNT162b2 vaccine in maintenance dialysis patients.

BACKGROUND AND OBJECTIVES: Highly effective vaccines against severe acute respiratory syndrome virus 2 have been developed and administered worldwide. However, protection from coronavirus disease 2019 is not absolute and an optimal vaccination regimen needs to be established. This study assessed the clinical efficacy of the coronavirus disease 2019 vaccine among dialysis patients receiving 3 or 4 doses of vaccine. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: This retrospective study was conducted using the electronic database of Clalit Health Maintenance Organization in Israel. Chronic dialysis patients treated with either hemodialysis or peritoneal dialysis during the coronavirus disease 2019 pandemic were included. We compared clinical outcomes of patients who had received three or four doses of the severe acute respiratory syndrome virus 2 vaccine. RESULTS: This study included 1,030 patients on chronic dialysis, with a mean age of 68 ± 13 years. Among them, 502 patients had received 3 doses of the vaccine and 528 received 4 doses. Severe acute respiratory syndrome virus 2 infection rates, severe COVID-19 that resulted in hospitalizations, COVID-19-related mortality and all-cause mortality rates were lower among chronic dialysis patients who received a fourth dose of vaccine as compared to those who received only 3 doses (after controlling for age, sex and comorbidities). Despite lower mortality rates observed with the Omicron variant, the fourth dose was significantly associated with reduced COVID-19-related mortality (1.7% vs. 3.8%, p = 0.04). Odds ratio for COVID-19-related mortality was 0.44 with 95% CI 0.2-0.98. CONCLUSIONS: As seen in the general population and with previous vaccine boosters, the fourth dose of the BNT162b2 vaccine reduced rates of severe COVID-19-related hospitalization and mortality among chronic dialysis patients. Further studies are needed to establish the optimal regimens of vaccination for patients on chronic dialysis.

A pilot trial of Thymalfasin (Ta1) to prevent covid-19 infection and morbidities in renal dialysis patients: Preliminary report.

PURPOSE: Patients with end-stage renal disease (ESRD) on hemodialysis (HD) are considered particularly susceptible to infection with SARS-CoV2 on the basis of the immunodeficiency associated with advanced age, comorbidity burden, medication use, and need for frequent visits to dialysis clinics. In prior studies, thymalfasin (thymosin alpha 1, Ta1) has been shown to enhance antibody response to influenza vaccine and reduce influenza infection in geriatric populations, including hemodialysis patients, when used as an adjunct to influenza vaccine. Early in the COVID-19 pandemic we speculated that administration of Ta1 to HD patients would result in reduced rate and severity of COVID-19 infection. We also hypothesized that HD patients treated with Ta1 who did become infected with COVID-19 would have a milder course of infection in terms of hospitalization rates, requirement for and length of ICU stays, requirement for mechanical ventilation, and survival. Further, we proposed that patients who avoided COVID-19 infection during the study would have decreased non-COVID-19 infections and hospitalizations compared to controls. PROCEDURES: The study launched in January 2021 and, as of July 1, 2022, 254 ESRD/ HD patients from five dialysis centers in Kansas City, MO have been screened. Of these, 194 patients have been randomized 1:1 to either Group A (1.6 mg Ta1 given subcutaneously twice weekly for 8 weeks), or Group B (control group not receiving Ta1). After the 8-week treatment period, subjects were followed for an additional 4 months and monitored for safety and efficacy. A data safely monitoring board reviewed all reported adverse effects and commented on study progress. RESULTS: To date, only 3 deaths have occurred in subjects treated with Ta1 (Group A), compared to 7 in the control (Group B). There have been 12 COVID-19 related serious adverse effects (SAEs; 5 in Group A, and 7 in Group B). The majority of patients have received a COVID-19 vaccine (91 patients in group A, and 76 patients in Group B) at various times throughout the study. Nearing completion of the study, blood samples have been collected and antibody responses to COVID-19 will be analyzed along with safety and efficacy endpoints when all subjects have completed the study.

Quality of life in people with hemodialysis treatment in Ecuador / Calidad de vida en personas con tratamiento hemodialítico del Ecuador

Objective: to determine the Quality of Life of people on hemodialysis in two provinces of Zone # 6 of Ecuador. Method: cross-sectional descriptive quantitative, intentional sample of 70 participants, developed in two hemodialysis units, a sociodemographic-clinical structured questionnaire and the Kidney Disease Quality of Life (KDQOL™-36) were applied, after signing the informed consent. The data were analyzed by descriptive statistics. Results: the evaluated Quality of Life obtained an average of 57.05, more than 50% of the participants obtained scores below 50 on a scale of 1 to 100, in the Burden of Kidney Disease, Physical Component and Mental Component three affected sub-scales out of a total of five. Conclusion: the Quality of Life of the population on hemodialysis is good; however, low scores were identified in three subscales; In this context, the need for nursing intervention plans to promote health and that could improve the quality of life is identified.

Objetivo: determinar la Calidad de Vida de las personas hemodializadas en dos provincias de la Zona # 6 de Ecuador. Método: cuantitativo descriptivo transversal, muestra intencional de 70 participantes, desarrollado en dos unidades de hemodiálisis, se aplicó un cuestionario estructurado sociodemográfico - clínico y el Kidney Disease Quality of Life (KDQOL™-36), previa firma del consentimiento informado. Los datos fueron analizados por estadística descriptiva. Resultados: la Calidad de Vida evaluada obtuvo un promedio de 57,05, más del 50% de los participantes obtuvieron puntajes inferiores a 50 de una escala de 1 a 100, en la Carga de la Enfermedad del Riñón, Componente Físico y Componente Mental tres sub-escalas afectadas de un total de cinco. Conclusión: la Calidad de Vida de la población en hemodiálisis es buena; sin embargo, se identificó bajas puntuaciones en tres sub-escalas; en este contexto, se identifica la necesidad de planes de intervención de enfermería para promover la salud y que podrían mejorar la calidad de vida.

Significado de la hemodiálisis para la persona con enfermedad renal crónica / Meaning of hemodialysis for a person with chronic kidney disease

Introducción: La Enfermedad Renal se considera un problema de salud pública asociado a los estilos de vida de la población. El progreso de la enfermedad a estadio terminal requiere tratamiento de hemodiálisis, condición de salud que genera cambios a nivel social, económico, emocional y físico.Objetivo: Describir los significados que asigna la persona con enfermedad renal crónica al tratamiento de hemodiálisis.Material y Método: Investigación cualitativa, con enfoque en la teoría fundamentada. Al estudio se vincularon 18 personas mayores de 18 años de edad y en tratamiento de hemodiálisis. La recolección de la información se hizo a través de entrevistas en profundidad hasta conseguir la saturación teórica. El análisis de los datos se llevó a cabo en el programa ATLAS.ti9. Resultados: Se hallaron cuatro categorías: perdiendo la función renal, modificando los estilos de vida, cambiando la forma de vivir con la hemodiálisis y viviendo con hemodiálisis, estas categorías, simbolizan los significados al tratamiento de hemodiálisis. Conclusión: El tratamiento con hemodiálisis cambia el pronóstico de la enfermedad renal crónica, disminuyendo la morbilidad y la mortalidad. La persona durante el tratamiento debe adaptarse y enfrentar cambios físicos, fisiológicos, emocionales, sociales y familiares.(AU)

Introduction: Kidney disease is considered a public health problem directly associated with people’s lifestyles. The disease ́s evolution into the terminal stage requires hemodialysis treatment, a health situation that generates changes at a social, economic, emotional, and physical level.Objective: To describe the meaning that patients with chronic kidney disease link to hemodialysis treatment.Material and Method: Qualitative research, focusing on solid base theory. Eighteen people over 18 years old and undergoing hemodialysis treatment were considered in the survey. The information gathering was carried out through indepth interviews until theoretical saturation was achieved. Data analysis was carried out using ATLAS.ti9 program.Results: Four categories were found: 1) losing kidney function, 2) changing lifestyles, 3) changing the way of living with hemodialysis treatment, and 4) living with hemodialysis treatment. These categories provide further meaning to hemodialysis treatment.Conclusions: Hemodialysis treatment changes the prognosis of chronic kidney disease, reducing morbidity and mortality. During the treatment, the patient must face and get adapted to physical, physiological, emotional, social, and family changes.(AU)

Tecnologias educacionais utilizadas pelo enfermeiro junto ao idoso em hemodiálise: um protocolo de revisão de escopo / Educational technologies used by the nurse with the elderly on hemodialysis: a scoping review protocol

OBJETIVO: Mapear as tecnologias educacionais utilizadas pelo enfermeiro no cuidado ao idoso em hemodiálise. MÉTODO: Trata-se de um protocolo de revisão de escopo desenvolvido com base nas recomendações do Manual do Instituto Joanna Briggs e registrado na Open Science Framework: https://osf.io/9qfge. A busca pelos artigos será realizada nas bases de dados Medline/PubMed, Scopus, Web of Science, Embase, LILACS, BDENF, CINAHL e Google Scholar. Serão considerados elegíveis os estudos que respondam à pergunta de pesquisa "Quais são as tecnologias educacionais utilizadas pelo enfermeiro ao idoso em hemodiálise?". Dois revisores atuarão de maneira independente para promover a seleção dos artigos. O software Rayyan será utilizado como ferramenta para auxiliar no arquivamento dos documentos. As listas de referências dos artigos selecionados também serão consultadas. Caso haja divergências entre os revisores, um terceiro revisor fará a apreciação para resolver as discordâncias. Para a síntese e extração dos dados, os autores utilizarão um formulário previamente elaborado. A apresentação dos resultados será feita por meio de quadros, fluxogramas, resumo e discussão narrativa.

OBJECTIVE: To identify the educational technologies used by nurses in the care of the elderly on hemodialysis. METHOD: This is a scoping review protocol developed based on the recommendations of the Joanna Briggs Institute Manual and registered with the Open Science Framework: https://osf.io/9qfge. Articles will be searched in Medline/PubMed, Scopus, Web of Science, Embase, LILACS, BDENF, CINAHL, and Google Scholar databases. Studies that answer the research question, "What educational technologies are used by nurses working with the elderly in hemodialysis?" will be considered eligible. Two reviewers will work independently to select articles. Rayyan software will be used as a tool to assist in document archiving. The reference lists of the selected articles will also be consulted. A third reviewer will assess the disagreement in case of disagreement between the reviewers. For data synthesis and extraction, the authors will use a pre-designed form. The results will be presented in tables, flowcharts, summaries, and narrative discussions.

Guidelines on vascular access for hemodialysis from the Brazilian Society of Angiology and Vascular Surgery / Diretrizes sobre acesso vascular para hemodiálise da Sociedade Brasileira de Angiologia e de Cirurgia Vascular

Abstract Chronic kidney disease is a worldwide public health problem, and end-stage renal disease requires dialysis. Most patients requiring renal replacement therapy have to undergo hemodialysis. Therefore, vascular access is extremely important for the dialysis population, directly affecting the quality of life and the morbidity and mortality of this patient population. Since making, managing and salvaging of vascular accesses falls within the purview of the vascular surgeon, developing guideline to help specialists better manage vascular accesses for hemodialysis if of great importance. Thus, the objective of this guideline is to present a set of recommendations to guide decisions involved in the referral, evaluation, choice, surveillance and management of complications of vascular accesses for hemodialysis.

Resumo A doença renal crônica é um problema de saúde pública global e em seu estágio terminal está associada à necessidade de terapia dialítica. A grande maioria dos pacientes que necessitam realizar a terapia renal substitutiva, a fazem através da hemodiálise. Portanto, o acesso vascular é de extrema importância para a população dialítica, implicando diretamente na qualidade de vida e na morbimortalidade deste grupo de pacientes. Sendo a confecção, gerenciamento e resgate dos acessos vasculares uma das áreas de atuação do cirurgião vascular, é de grande importância a elaboração de uma diretriz que oriente o especialista no manejo mais adequado do acesso vascular para hemodiálise. Assim, o objetivo desta diretriz é apresentar um conjunto de recomendações para guiar as decisões na referenciação, avaliação, escolha, vigilância e gestão das complicações do acesso vascular para hemodiálise.

Segurança do paciente na hemodiálise: uma perspectiva sociodemográfica, laboratorial e farmacológica / Patient safety in hemodialysis: a sociodemographic, laboratory and pharmacological perspective / Seguridad del paciente en hemodiálisis: una perspectiva sociodemográfica, de laboratorio y farmacológica

O objetivo deste estudo é analisar as características sociodemográficas, laboratoriais e farmacológicas de indivíduos que sofreram complicações e eventos adversos durante a hemodiálise. Trata-se de estudo descritivo, transversal e documental. Realizado em uma clínica de terapia renal substitutiva de uma regional de saúde do noroeste do Paraná. A população foi composta de 151 portadores de doença renal crônica em estágio 5 hemodialítico e seus respectivos prontuários, e que faziam tratamento financiado pelo Sistema Único de Saúde. A coleta de dados ocorreu por meio de um questionário semiestruturado nos meses de junho e julho de 2019. A análise dos dados foi por meio de estatística descritiva. Entre os resultados, evidenciou-se que dos 151 participantes, todos tiveram alguma complicação/eventos durante a hemodiálise. Destacaram-se o sexo masculino (61%), idosos (46,4%), residentes no Noroeste do Paraná (46%), trabalhador rural (23%), pardos (46,4%) e renda de até dois salários mínimos (53%). Foram identificados dados de 37 tipos de exames nos prontuários, com predominância (100%) de ureia, hemoglobina e hematócrito. 44 participantes relataram uso regular de medicação, os medicamentos mais utilizados são a eritropoietina humana recombinante (89%), anti-hipertensivos (70%), sacrato de hidróxido férrico (68%) e cloridrato de sevelâmer (n=98; 65%). Conclui-se que as características que contemplaram o estudo permitiu a identificação ampliada de complicações e eventos que comprometem a segurança do paciente. Assim, destaca-se a importância de compreender os fatores de risco e planejar ações para a melhoria do cuidado.

The objective of this study is to analyze the sociodemographic, laboratory and pharmacological characteristics of individuals who suffered complications and adverse events during hemodialysis. This is a descriptive, cross-sectional and documentary study. Performed at a renal replacement therapy clinic in a health district in northwestern Paraná. The population consisted of 151 patients with chronic kidney disease undergoing hemodialysis stage 5 and their respective medical records, who were receiving treatment financed by the Unified Health System. Data collection took place through a semi-structured questionnaire in June and July 2019. Data analysis was through descriptive statistics. Among the results, it was evidenced that of the 151 participants, all had some complication/events during hemodialysis. Males (61%), elderly (46.4%), residents of Northwest Paraná (46%), rural workers (23%), browns (46.4%) and income of up to two minimum wages stood out. (53%). Data from 37 types of tests were identified in the medical records, with a predominance (100%) of urea, hemoglobin and hematocrit. 44 participants reported regular use of medication, the most used drugs are recombinant human erythropoietin (89%), antihypertensives (70%), ferric hydroxide sacrate (68%) and sevelamer hydrochloride (n=98; 65%). It is concluded that the characteristics that contemplated the study allowed the expanded identification of complications and events that compromise patient safety. Thus, the importance of understanding risk factors and planning actions to improve care is highlighted.

El objetivo de este estudio es analizar las características sociodemográficas, de laboratorio y farmacológicas de individuos que sufrieron complicaciones y eventos adversos durante la hemodiálisis. Se trata de un estudio descriptivo, transversal y documental. Realizado en una clínica de terapia de reemplazo renal en un distrito de salud en el noroeste de Paraná. La población estuvo conformada por 151 pacientes con enfermedad renal crónica en hemodiálisis estadio 5 y sus respectivas historias clínicas, quienes recibían tratamiento financiado por el Sistema Único de Salud. La recolección de datos se realizó a través de un cuestionario semiestructurado en junio y julio de 2019. El análisis de datos se realizó mediante estadística descriptiva. Entre los resultados, se evidenció que, de los 151 participantes, todos tuvieron alguna complicación/eventos durante la hemodiálisis. Se destacaron hombres (61%), ancianos (46,4%), residentes en el Noroeste de Paraná (46%), trabajadores rurales (23%), pardos (46,4%) e ingresos de hasta dos salarios mínimos (53%). Se identificaron datos de 37 tipos de pruebas en las historias clínicas, con predominio (100%) de urea, hemoglobina y hematocrito. 44 participantes informaron el uso regular de medicamentos, los medicamentos más utilizados son la eritropoyetina humana recombinante (89%), los antihipertensivos (70%), el sacrato de hidróxido férrico (68%) y el clorhidrato de sevelámero (n=98; 65%). Se concluye que las características que contempló el estudio permitieron la identificación

Financial toxicity in people with chronic kidney disease undergoing hemodialysis treatment / Toxicidad financiera en personas con enfermedad renal crónica en tratamiento de hemodiálisis / A toxicidade financeira em pessoas com doença renal crônica em tratamento hemodialítico

ABSTRACT Objective: to assess the financial toxicity of people with chronic kidney disease undergoing hemodialysis treatment. Method: a descriptive analytical cross-sectional study, carried out with 214 people, between February and May 2022. For data collection, a sociodemographic and clinical instrument and the COmprehensive Score for financial Toxicity were used. For analysis, the Odds Ratio, ANOVA and Cronbach's alpha tests were used. Results: the mean financial toxicity score was 20.30. Women with a monthly family income of at most two minimum wages are more likely to have some degree of financial toxicity (Odds Ratio: 0.85; 0.76). Conclusion: financial toxicity was identified to different degrees and varied according to sociodemographic and clinical characteristics. Measuring financial toxicity can help nurses plan care and develop strategies to avoid interrupting treatment.

RESUMEN Objetivo: evaluar la toxicidad financiera de personas con enfermedad renal crónica en tratamiento de hemodiálisis. Método: estudio transversal analítico descriptivo, realizado con 214 personas, entre febrero y mayo de 2022. Para la recolección de datos se utilizó un instrumento sociodemográfico, clínico y el COmprehensive Score for financial Toxicity. Para el análisis se utilizaron las pruebas de Odds Ratio, ANOVA y alfa de Cronbach. Resultados: la puntuación media de toxicidad financiera fue de 20,30. Las mujeres con un ingreso familiar mensual de a lo sumo dos salarios mínimos tienen más probabilidades de tener algún grado de toxicidad financiera (Odds Ratio: 0,85; 0,76). Conclusión: la toxicidad financiera se identificó en diferentes grados y varió según las características sociodemográficas y clínicas. Medir la toxicidad financiera puede ayudar a las enfermeras a planificar la atención y desarrollar estrategias para evitar la interrupción del tratamiento.

RESUMO Objetivo: avaliar a toxicidade financeira de pessoas com doença renal crônica em tratamento hemodialítico. Método: estudo descritivo analítico com corte transversal, realizado com 214 pessoas, entre os meses de fevereiro e maio de 2022. Para coleta de dados, utilizou-se instrumento sociodemográfico e clínico e o COmprehensive Score for financial Toxicity. Para análise, utilizaram-se os testes Odds Ratio, ANOVA e alfa de Cronbach. Resultados: a média do escore da toxicidade financeira foi de 20,30. Pessoas do sexo feminino e com renda familiar mensal de no máximo dois salários mínimos têm maiores chances de apresentar algum grau de toxicidade financeira (Odds Ratio: 0,85; 0,76). Conclusão: a toxicidade financeira foi identificada em diferentes graus e variou de acordo com as características sociodemográficas e clínicas. A mensuração da toxicidade financeira pode auxiliar o enfermeiro no planejamento do cuidado e na elaboração de estratégias para evitar a interrupção do tratamento.

Brazilian registry for the elimination of hepatitis C in dialysis units: a call to action for Nephrology / Registro brasileiro para eliminação da hepatite C nas unidades de diálise: um chamado para a Nefrologia

Abstract Infection by the hepatitis C virus is more prevalent in patients on dialysis than in the general population in Brazil, and has been associated with worse outcomes. Current therapy for hepatitis C is highly effective, safe, and widely available in Brazil, with coverage provided to dialysis patients with chronic kidney disease, which makes the elimination of hepatitis C a viable target. The Brazilian Society of Nephrology, the Brazilian Society of Hepatology, and the Brazilian Liver Institute developed the "Brazilian Registry for the Elimination of Hepatitis C in Dialysis Units". This project aims to identify, treat, and monitor the response to treatment of patients on chronic dialysis infected with the hepatitis C virus in Brazil. This article presents the issue and invites Brazilian nephrologists to rally around the achievement of a significant goal.

Resumo A infecção pelo vírus da hepatite C é mais prevalente em pacientes em diálise do que na população geral no Brasil e implica um pior prognóstico. O tratamento atual para hepatite C é altamente eficaz, seguro e disponível no país, inclusive para a população de pacientes crônicos em diálise, o que torna a eliminação do vírus da hepatite C uma meta viável. A Sociedade Brasileira de Nefrologia, a Sociedade Brasileira de Hepatologia e o Instituto Brasileiro do Fígado desenvolveram o "Registro Brasileiro para Eliminação da Hepatite C nas Unidades de Diálise". O projeto visa identificar pacientes em diálise crônica com vírus da hepatite C no Brasil, além de tratar e monitorar a resposta virológica após o tratamento. Este breve artigo apresenta o problema e convida os nefrologistas brasileiros a unirem forças nesse objetivo comum.

Peritonitis esclerosante encapsulante: una causa rara de obstrucción intestinal / Sclerosing encapsulating peritonitis: a rare cause of intestinal obstruction

RESUMEN La peritonitis esclerosante encapsulante es una rara entidad de baja incidencia. Su fisiopatología no está clara, reconociéndose dos tipos: idiopática y secundaria, esta última generalmente como complicación de la diálisis peritoneal. Su diagnóstico suele ser tardío manifestándose con clínica de obstrucción intestinal. Es importante conocer los signos radiológicos. Asocia una alta mortalidad, por lo que es fundamental sospecharla precozmente e incluirla en el diagnóstico diferencial de los cuadros de obstrucción intestinal. Presentamos el caso de una obstrucción intestinal como forma de presentación de una peritonitis esclerosante encapsulante.

ABSTRACT Sclerosing encapsulating peritonitis is a rare condition with a low incidence rate. The pathophysiology of this disease is not clear, though two types are distinguished: idiopathic and secondary; the latter usually occurs as a peritoneal dialysis complication. The diagnosis of the condition is usually delayed and it presents with intestinal obstruction. It is important to know the X-ray findings. This disease is associated with a high mortality rate; therefore, early detection and a differential diagnosis in cases of intestinal obstruction are important. We report a case of intestinal obstruction as a clinical manifestation of sclerosing encapsulating peritonitis.

Long-term complications of systemic oxalosis in children-a retrospective single-center cohort study.

BACKGROUND: Systemic oxalosis is a severe complication seen in primary hyperoxaluria type I patients with kidney failure. Deposition of insoluble calcium oxalate crystals in multiple organs leads to significant morbidity and mortality. METHODS: We describe a retrospective cohort of 11 patients with systemic oxalosis treated at our dialysis unit from 1982 to 1998 (group 1) and 2007-2019 (group 2). Clinical and demographic data were collected from medical records. Imaging studies were only available for patients in group 2 (n = 5). RESULTS: Median age at dialysis initiation was 6.1 months (IQR 4-21.6), 64% were male. Dialysis modality was mostly peritoneal dialysis in group 1 and daily hemodialysis in group 2. Bone disease was the first manifestation of systemic oxalosis, starting with the appearance of sclerotic bands (mean 166 days, range 1-235), followed by pathological fractures in long bones (mean 200.4 days, range 173-235 days). Advanced disease was characterized by vertebral fractures with resulting kyphosis, worsening splenomegaly, and adynamic bone disease. Two patients developed pulmonary hypertension, 4 and 8 months prior to their death. Four of 11 patients developed hypothyroidism 0-60 months after dialysis initiation. Only one patient survived after a successful liver-kidney transplantation. Four patients died after liver or liver-kidney transplantation. CONCLUSIONS: This is the first comprehensive description of the natural history of pediatric systemic oxalosis. We hope that our findings will provide basis for a quantitative severity score in future, larger studies.

Teste alfa de uma tecnologia gamificada para crianças e adolescentes em hemodiálise / Prueba alfa de una tecnología gamificada para niños y adolescentes en hemodiálisis / Alfa test of a gamified technology for children and adolescents in hemodialysis

RESUMO Objetivo apresentar o teste alfa do protótipo de uma tecnologia gamificada, o Nefro Hero ®, com foco na Qualidade de Vida Relacionada à Saúde de pacientes pediátricos em tratamento hemodialítico. Método pesquisa metodológica, avaliativa, por meio do teste alfa, com abordagem quantitativa, realizada com oito pacientes em tratamento hemodialítico com idades entre oito e 16 anos. Foi desenvolvida em quatro etapas: primeira aplicação do inventário de QVRS DISABKIDS®; nove sessões de jogo com os pacientes, individualmente, durante as sessões de hemodiálise; segunda aplicação do inventário; duas sessões de brainstorming. Resultados entre a primeira e a segunda aplicações do inventário, foram identificadas melhorias no domínio mental na QVRS dos pacientes, indicando o potencial da função primária da estratégia. Foram levantados pontos para ser revistos na tecnologia antes da etapa de validação. Conclusão e implicações para a Enfermagem por ser um teste alfa, os resultados não podem ser generalizados, mas indicam o potencial da estratégia. O artigo apresenta uma etapa de avaliação anterior à de validação, fundamental ao desenvolvimento de tecnologias em formato de jogos e ainda pouco explorada.

RESUMEN Objetivo presentar la prueba alfa del prototipo de tecnología gamificada, Nefro Hero®, con foco en la Calidad de Vida Relacionada con la Salud en pacientes pediátricos en hemodiálisis. Método investigación metodológica, evaluativa, mediante la prueba alfa, con abordaje cuantitativo, realizada con ocho pacientes en hemodiálisis con edades comprendidas entre los ocho y los 16 años. Se desarrolló en cuatro etapas: primera aplicación del inventario HRQL DISABKIDS®; nueve sesiones de juego con pacientes individualmente durante las sesiones de hemodiálisis; segunda aplicación del inventario; dos sesiones de brainstorming. Resultados entre la primera y la segunda aplicación del inventario, se identificaron mejoras en el dominio mental de la CVRS de los pacientes, indicando el potencial de la función primaria de la estrategia. Se plantearon puntos para ser revisados ​​en la tecnología antes de la etapa de validación. Conclusión e implicaciones para Enfermería al tratarse de una prueba alfa, los resultados no pueden generalizarse, pero indican el potencial de la estrategia. El artículo presenta una etapa de evaluación previa a la validación, fundamental para el desarrollo de tecnologías de formatos de juego y aún poco explorada.

ABSTRACT Objective to present the alpha test of a prototype of a gamified technology, the Nefro Hero®, focused on the Health-Related Quality of Life of pediatric patients on hemodialysis treatment. Method a methodological, evaluative research, through the alpha test, with quantitative approach, carried out with eight patients on hemodialysis treatment aged between eight and 16 years. It was developed in four stages: first application of the DISABKIDS® HRQoL inventory; nine game sessions with the patients, individually, during the hemodialysis sessions; second application of the inventory; two brainstorming sessions. Results between the first and second applications of the inventory, improvements were identified in the mental domain in the patients' HRQoL, indicating the potential of the primary function of the strategy. Points to be reviewed in the technology before the validation stage were raised. Conclusion and Implications for Nursing as it is an alpha test, the results cannot be generalized, but they indicate the potential of the strategy. The article presents an evaluation stage prior to validation, fundamental to the development of game-format technologies and still little explored.

Factores asociados a las úlceras en miembros inferiores del paciente con enfermedad renal crónica en un centro de diálisis / Factors Associated with Ulcers in the Lower Limbs of a Patient with Chronic Kidney Disease in a Dialysis Center / Fatores associados a úlceras nos membros inferiores de um paciente com doença renal crônica em um centro de diálise

Introducción: las personas adultas con enfermedad renal crónica (ERC) tienen mayor riesgo de presentar úlceras, especialmente en las extremidades inferiores. Sin embargo, existen datos limitados sobre la prevalencia y los factores asociados. Objetivo: determinar la prevalencia de úlceras en miembros inferiores y sus factores asociados en pacientes con enfermedad renal crónica que asisten a una institución de IV nivel de complejidad. Método: estudio de tipo observacional, transversal y analítico, la muestra fue de 561 participantes. Los instrumentos fueron una ficha de datos sociodemográcos y de antecedentes, y el índice tobillo brazo (ITB). Resultados: los participantes fueron en su mayoría hombres (67%), con promedio de edad de 62 años; se encontró significancia estadística (p < 0,05) entre las variables antecedente de diabetes, ITB bajo, haber tenido úlcera previa y presencia de úlcera en miembros inferiores. Conclusiones: estudiar este tipo de fenómenos en unidades de cuidado renal se convierte en una necesidad debido a la alta prevalencia y a los factores de riesgo asociados. Esto permite la planicación de estrategias encaminadas a la prevención.

Introduction: adults with chronic kidney disease (CKD) have a higher risk of developing ulcers, especially lower extremities. However, there are limited data on prevalence and associated factors. Objective: to determine the prevalence of ulcers in the lower limbs and their associated factors in patients with chronic kidney disease who attend a IV level of complexity institution. Method: observational, cross-sectional, and analytical study, the sample was 561 participants. The instruments were a sociodemographic and background datasheet and the Ankle-Brachial Index (ABI). Results: the participants were primarily men (67%), with an average age of 62 years; Statistical significance (p <0.05) was found between the variables history of diabetes, low ABI, having had a previous ulcer, and the presence of an ulcer in the lower limbs. Conclusions: studying this phenomenon in renal care units becomes necessary due to the high prevalence and associated risk factors; it allows the planning of strategies aimed at prevention.

Introdução: adultos com doença renal crônica (DRC) apresentam maior risco de desenvolver úlceras, principalmente nas extremidades inferiores. No entanto, existem dados limitados sobre prevalência e fatores associados. Objetivo: determinar a prevalência de úlceras de membros inferiores e seus fatores associados em pacientes com doença renal crônica atendidos em instituição de nível de complexidade IV. Método: estudo observacional, transversal e analítico, a amostra foi de 561 participantes. Os instrumentos foram ficha sociodemográfica e de antecedentes e o índice tornozelo-braquial (ITB). Resultados: os participantes eram em sua maioria homens (67%), com média de idade de 62 anos; Foi encontrada significância estatística (p < 0,05) entre as variáveis antecedente, baixo ITB, ter tido úlcera prévia e presença de úlcera em membros inferiores. Conclusões: o estudo desse tipo de fenômeno em unidades de cuidados renais torna-se uma necessidade devido à alta prevalência e aos fatores de risco associados. Isso permite o planejamento de estratégias encaminhadas à prevenção.

Short period of high-intensity inspiratory muscle training improves inspiratory muscle strength in patients with chronic kidney disease on hemodialysis: a randomized controlled trial.

BACKGROUND: Chronic kidney disease is a complex disease that impacts multiple organs and systems (including musculoskeletal and cardiorespiratory) leading to reduction of functional capacity. OBJECTIVE: The aim of this study was to investigate the effect of a short period of high intensity inspiratory muscle training on maximum inspiratory pressure, functional capacity and endothelial function of chronic kidney disease patients on hemodialysis. METHODS: This randomized controlled trial enrolled 25 patients who were allocated into two groups: intervention (IMTG=14) and control (CG=11) groups. Intervention patients received the exercise protocol over a period of 5 weeks, 6 times per week, with each session consisting of 5 sets of 10 repetitions with an initial load of 50% progressing to 70% of maximum inspiratory pressure , measured weekly. The primary outcome was inspiratory muscle strength and the secondary outcomes were functional capacity and endothelial function evaluated before and after the training protocol. RESULTS: The inspiratory muscle training induced a marked improvement in maximum inspiratory pressure which was evident after the training period (mean difference 19.0cmH2O - 95%CI 0.4-37.5; IMTG: 102±25.7cmH2O vs CG: 83±19.2; p=0.046). The magnitude of maximum inspiratory pressure improvement was 33.5% at the end of the protocol for the IMTG. Functional capacity and endothelial function did not vary between or within groups. CONCLUSION: A short period of high-intensity inspiratory muscle training for five weeks was able to improve inspiratory muscle strength of chronic kidney disease patients on hemodialysis (ClinicalTrials.gov registration NCT03082404).

The Prognostic Value of Soluble ST2 in Maintenance Hemodialysis Patients: A Meta-Analysis.

BACKGROUND: Much controversy remains in the literature with respect to whether soluble suppression of tumorigenicity 2 (sST2) can serve to predict all-cause death in patients undergoing maintenance hemodialysis (MHD). This meta-analysis therefore sought to analyze extant datasets exploring the association between these 2 variables in MHD patients in order to draw relevant conclusions. METHODS: Articles published through December 2018 in PubMed and Embase were independently reviewed by 2 authors to identify relevant articles, and STATA 12.0 was used for statistical analyses of relevant results and study parameters. RESULTS: In total, we identified 4 relevant studies that were incorporated into this meta-analysis. These studies included a total of 1,924 participants (60% male, mean follow-up 911 days). The combined study results suggested that increased levels of sST2 were significantly linked to a 2.23 fold rise in all-cause mortality (hazard ratio [HR] 2.23, 95% CI 1.81-2.75). Subgroup analyses confirmed that this same association was true in patients undergoing hemodialysis (HR 2.17, 95% CI 1.74-2.71), which indicated that the increased levels of sST2 were significantly linked to a 2.17 fold rise in all-cause mortality. CONCLUSIONS: This analysis suggests that there is a significant link between elevated levels of sST2 and death in patients undergoing MHD. Further large-scale trials, however, will be needed to fully validate these findings and their clinical relevance.

Identificação de diagnósticos de enfermagem em nefropatas em hemodiálise à luz da teoria das necessidades humanas básicas / Identification of nursing diagnoses in nephropates in hemodialysis in the light of the theory of basic human needs / Identificación de diagnosticos de enfermería en nefropathes en hemodialisis a la luz dela teoría de las necesidades básicas

Introdução: Nefropatas em tratamento hemodialítico necessitam de assistência de enfermagem qualificada. Objetivo: Identificar os domínios e títulos diagnósticos de enfermagem recorrentes em pacientes em hemodiálise, segundo a taxonomia da NANDA­ I. Material e Método: Estudo descritivo e transversal, desenvolvido no setor de Terapia Renal Substitutiva (TRS) de um hospital de Catanduva-SP. Participaram 78 pacientes em tratamento por hemodiálise. Na coleta de dados utilizaram-se dois instrumentos: um questionário sobre aspectos sociodemográficos e caracterização clínica dos participantes e outro instrumento para a realização da anamnese e do exame físico, segundo o Modelo Conceitual de Wanda Horta. Os diagnósticos de enfermagem foram elaborados utilizando a taxonomia da NANDA-I (2018-2020) considerando apenas os domínios e títulos diagnósticos, sendo ponderadas as medidas de tendência central e percentil. Resultado: Houve equivalência entre os gêneros, cuja idade mediana foi de 58 anos; raça branca (57,7%); ensino fundamental incompleto (60,3%), moradores da região de Catanduva (61,5%); portadores de Insuficiência Renal Crônica (91%); tempo de hemodiálise até dois anos (42,3%). Foram identificados 44 diagnósticos de enfermagem, destes, 50,8% foram de risco, predominando o risco de infecção (100%), enquanto 49,2% tinham foco no problema, para estilo de vida sedentária (73,1%). Conclusão: Estes resultados refletem o panorama dos diagnósticos de enfermagem recorrentes em pessoas com patologia renal.(AU)

Introduction: Nephropaths undergoing hemodialysis require qualified nursing assistance. Objective: To identify domains and recurrent nursing diagnostic titles in hemodialysis patients, according to the NANDA­I taxonomy. Material and Method: Descriptive and transversal study, developed in the Renal Replacement Therapy (RRT) sector of a hospital in Catanduva-SP. 78 patients undergoing hemodialysis treatment participated. In data collection, two instruments were used: a questionnaire on sociodemographic aspects and clinical characterization of the participants and another instrument for conducting anamnesis and physical examination, according to the Conceptual Model of Wanda Horta. Nursing diagnoses were prepared using the NANDA-I taxonomy (2018-2020) considering only the domains and diagnostic titles, with measures of central tendency and percentile being weighted. Result: There was equivalence between genders, whose median age was 58 years; white race (57.7%); incomplete primary education (60.3%), residents of the Catanduva region (61.5%); patients with Chronic Renal Failure (91%); hemodialysis time up to two years (42.3%). 44 nursing diagnoses were identified, of which 50.8% were at risk, with a predominant risk of infection (100%), while 49.2% focused on the problem, for a sedentary lifestyle (73.1%). Conclusion: These results reflect the panorama of recurrent nursing diagnoses in people with renal pathology.(AU)

Introducción: Los pacientes renales que se someten a hemodiálisis requieren asistencia de enfermería calificada. Objetivo: Identificar los dominios y títulos diagnósticos de enfermería recurrentes en pacientes en hemodiálisis, de acuerdo con la taxonomía NANDA-I. Material y Método: Estudio descriptivo y transversal, desarrollado en el sector de la Terapia de Reemplazo Renal (TRR) de un hospital en Catanduva-SP. 78 pacientes fueron sometidos a tratamiento por hemodiálisis. En la recolección de datos, se utilizaron dos instrumentos: un cuestionario sobre aspectos sociodemográficos y caracterización clínica de los participantes, y otro instrumento para realizar anamnesis y examen físico, de acuerdo con el Modelo Conceptual de Wanda Horta. Los diagnósticos de enfermería se realizaron utilizando la taxonomía NANDA-I (2018-2020) considerando solo los dominios y los títulos de diagnóstico, con medidas de tendencia central y percentil ponderado. Resultado: Hubo equivalencia entre géneros, cuya mediana de edad fue de 58 años; raza blanca (57.7%); educación primaria incompleta (60.3%), residentes de la región de Catanduva (61.5%); Insuficiencia Renal Crónica (91%); tiempo de hemodiálisis hasta dos años (42.3%). Se identificaron 44 diagnósticos de enfermería, de los cuales el 50.8% estaban en riesgo, con un riesgo predominante de infección (100%), mientras que el 49.2% se centró en el problema, para un estilo de vida sedentario (73.1%). Conclusión: Estos resultados reflejan el panorama de los diagnósticos de enfermería recurrentes en personas con patología renal.(AU)