RELATIONSHIP BETWEEN RESIDUAL DIURESIS AND SARCOPENIA IN PATIENTS ON HEMODIALYSIS.

OBJECTIVE: To assess the association of residual diuresis with sarcopenia in patients with Chronic Kidney Disease (CKD) on hemodialysis. METHODS: Through a cross-sectional study, patients on hemodialysis were subjected to a Dual Energy Radiologic Absorption (DEXA) exam to record muscle mass. Based on the volume of urine collected in 24 hours, patients were classified as anuric (diuresis ≤ 100 mL/day) or non-anuric (diuresis > 100 mL/day). Functional performance was evaluated by Short Physical Performance Battery (SPPB) and muscle strength by handgrip strength and 5-repetition sit-to-stand test. The association between the absence of residual urine and the presence of sarcopenia, low SPPB, and low muscle strength was analyzed using a binary logistic regression model. RESULTS: Ninety-two patients, with a mean age of 54.4 years (95% CI 51.3 - 57.4) and with a mean diuresis volume of 476.3 mL/day (95% CI 320.4 - 632.2) were evaluated (48 anuric and 44 non-anuric). Anuric patients had a 2.77 (95% CI 1.14 - 6.73) times greater probability of sarcopenia and had a 3.55 (1.14 - 11.0) times greater probability of low SPPB, regardless of gender, age, and time on dialysis. Gender was the other associated variable for the presence of sarcopenia, with males having a 3.30 (95% CI 1.34 - 8.13) times higher risk. There were no associations with muscle strength. CONCLUSION: The absence of residual diuresis in patients on hemodialysis is associated with a higher risk of sarcopenia and low functional performance.

Reliability and validity of the Patient Generated Index (PGI) in patients with chronic kidney disease (CKD) on dialysis, a new approach to quality of life.

PURPOSE: To evaluate the test-retest reliability and validity of the Patient Generated Index (PGI) in individuals with Chronic Kidney Disease (CDK) undergoing hemodialysis. METHODS: Through a non-experimental study with repeated measures, PGI was applied twice to assess internal consistency and test-retest reliability. Correlations with the Kidney Disease Quality of Life Short Form (KDQOL-SF), the Human Activity Profile (HAP) questionnaire, the Social Participation Scale, and the Glittre ADL Test were used. RESULTS: 91 individuals with CKD were evaluated. There was high reliability for the PGI (ICC= 0.97) PGI correlated with KQDOL - SF in Functional Capacity r = 0.38 (p < 0.001), Emotional Well-Being r = 0.31 (p = 0.003), Social Aspect r = 0.22 (p = 0.036), Emotional Function r = 0.22 (p = 0.038) and Effect of Kidney Disease r = 0.21 (p = 0.042), and Physical scores r = 0.24 (p = 0.021)), Mental r = 0.21 (p = 0.05) and General r = 0.22 (p = 0.037) summarized. There was a significant correlation between PGI and HAP r = 0.40 (p < 0.001) and the Social Participation Scale r = -0.36 (p < 0.001). There was no correlation between the PGI and Glittre ADL scores r = 0.12 (p = 0.247). CONCLUSION: In adults receiving hemodialysis, the PGI proved to be an accurate and reliable instrument for the assessment of the quality of life from the perspective of the patient.IMPLICATIONS FOR REHABILITATIONAlthough hemodialysis treatment is associated with increased survival and symptom control, there is a significant change in the patient's lifestyle.In order to provide a more focused view of the individual, the Patient Generated Index (PGI) was created to evaluate the quality of life.PGI is reliable and correlates with KQDOL - SF and the Social Participation Scale in this population.

Determining factors of functioning in hemodialysis patients using the international classification of functioning, disability and health.

BACKGROUND: Hemodialysis (HD) treatment affects functioning, physical activity level, clinical biomarkers, and body composition. However, the association between these variables with functioning, considering International Classification of Functioning, Disability and Health (ICF) domains remains unclear. Thus, the aim of this study was to investigate the possible association between physical activity, biomarkers, and body composition with functioning in HD patients in reference to the ICF. METHODS: Eighty HD patients performed different tests grouped according to ICF domain: Body structure and function - handgrip strength (HS), 5-repetition sit-to-stand test, and 60-s sit-to-stand test (5-STS, 60-STS, respectively); Activity - short physical performance battery (SPPB); and Participation - participation scale questionnaire. Physical activity [Human Activity Profile questionnaire (HAP)], body composition (Dual-energy X-ray absorptiometry), Parathormone (PTH), and alkaline phosphatase were analyzed as possible variables associated with ICF domains. Data analyses were performed using simple and multiple regression models adjusted for age, duration of HD, and diuresis volume. RESULTS: In the body structure and function domain, appendicular lean mass, PTH level, and age were associated with HS (R2 = 0.558); HAP and PTH were associated with 5-STS (R2 = 0.263); and HAP, PTH, duration of HD, and age were associated with 60-STS (R2 = 0.337). In the activity domain, HAP, PTH, alkaline phosphatase, duration of HD, age, and body fat were associated with SPPB (R2 = 0.689). Finally, only HAP was associated with the participation scale (R2 = 0.067). CONCLUSION: Physical activity and PTH levels are determinant protagonists of functioning in all ICF domains in hemodialysis patients.

The Glittre activities of daily living as a potential test for functional evaluation of patients on hemodialysis: a validation study.

PURPOSE: To investigate the validity and within-day reliability of the Glittre activities of daily living test (Glittre ADL-test) in patients on hemodialysis. METHODS: Ninety-one patients on hemodialysis were evaluated using Glittre ADL-test, functional tests, health-related quality of life, human activity profile, and social participation. Convergent validity was analyzed by the correlation analysis. The Glittre ADL-test results were compared among different levels of the functional tests, human activity profile, and participation (known-groups validity). Within-day reliability was examined by Intra-class Correlation Coefficient (ICC). RESULTS: There was a significant moderate to strong correlation between Glittre ADL-test and functional tests (r = 0.62 to 0.66 and -0.70 to -0.44). A significant weak correlation was found between Glittre ADL-test, health-related quality of life (r = 0.28 to 0.32), and human activity profile (r=-0.33). There was no significant correlation with participation. Except for participation level, the Glittre ADL-test results were able to identify individuals with low performance in all evaluated tests and were able to differentiate among inactive and active individuals by human activity profile (p < 0.05). Within-day reliability was evaluated in 42 patients. The ICC was 0.97. CONCLUSION: The Glittre ADL-test is a reliable test associated with functional parameters and physical aspects related to health-related quality of life, with potential value in the functional evaluation of patients on hemodialysis.Implications for rehabilitationFunctional impairment is a common clinical finding and is an important predictor of poor prognosis in patients on hemodialysis.The Glittre ADL-test has excellent within-day reliability and is a valid instrument for functional assessment in patients on hemodialysis.Activity limitations of patients on hemodialysis can be assessed by Glittre ADL-test.

Maximal inspiratory pressure is associated with health-related quality of life and is a reliable method for evaluation of patients on hemodialysis.

OBJECTIVE: To evaluate the association between Maximal Inspiratory Pressure (MIP) and health-related quality of life (HRQoL) and to verify the reliability of the MIP in patients on hemodialysis. METHODS: In a repeated-measures design, patients on hemodialysis performed MIP and specific HRQoL questionnaire (trial 1). The MIP was repeated after 6 to 8 weeks (trial 2) and reliability was assessed using Intra-class Correlation Coefficient. Standard Error of Measurement and Minimal Detectable Change scores were calculated. RESULTS: Sixty-one individuals (68.9% men) were evaluated in trial 1. MIP was associated with specific domains "Symptoms" (r = 0.45; R2 adjusted = 0.192) and the kidney disease component summary (r = 0.38; R2 adjusted = 0.138). Regarding generic domains, the MIP was associated with "Physical Functioning" (r = 0.57; R2 adjusted = 0.375) and Physical component summary (r = 0.47; R2 adjusted = 0.258). Thirty-three patients were randomly selected to perform a second MIP test (trial 2). The Intra-class Correlation Coefficient was 0.94 (95%CI 0.88-0.97). By Bland-Altman analysis, the bias was 3.2 cmH2O, which represents a difference of 3.7%. The Standard Error of Measurement and Minimal Detectable Change for MIP were 5.9 cmH2O and 13.8 cmH2O, respectively. CONCLUSION: The MIP is a reliable test, associated with physical domains of HRQoL in patients on hemodialysis. Thus, it is a useful method for respiratory evaluation in this population.

Percepção da qualidade de vida e autoestima após intervenção odontológica e transplante renal: uma série de casos / Quality of life perception and self-esteem after dental intervention and kidney transplantation: a case series

Contexto: a insuficiência renal crônica dá-se quando os rins deixam de desenvolver suas multitarefas com eficácia, levando o paciente à hemodiálise ou transplante renal e a um progressivo desgaste emocionalObjetivo:avaliar percepção da qualidade de vida relacionada à saúde bucal e autoestima de pacientes submetidos à hemodiálise, após intervenções odontológicas e transplantes renais. Materiais e Métodos: Oitenta e dois pacientes responderam aos questionários SF-36, OHIP-14 e Escala de Autoestima de Rosenberg. Destes, 76 passaram por intervenções odontológicas e responderam aos questionários novamente. Após 3 anos, apenas 33 deram continuidade ao estudo. Doze foram transplantados e 10 responderam aos questionários ao final. Resultados:Apenas a autoestima mostrou melhora, com alterações estatisticamente significativas. Conclusão:Tratamento odontológico e transplante renal melhoraram a autoestima dos pacientes. Houve uma tendência de melhora no aspecto social.

Background: Chronic kidney failure occurs when the kidneys fail to perform their multitasking effectively, leading the patient to hemodialysis or kidney transplantation and progressive emotional exhaustionObjective:to evaluate the perception of quality of life related to oral health and self-esteem of patients undergoing hemodialysis, after dental interventions and kidney transplants. Materials and Methods:Eighty-two patients answered the SF-36, OHIP-14 and Rosenberg Self-Esteem Scale questionnaires. Of these, 76 underwent dental interventions and answered the questionnaires again. After 3 years, only 33 continued the study. Twelve were transplanted and 10 completed the questionnaires. Results:Only self-esteem showed improvement, with statistically significant changes. Conclusion:Dental treatment and kidney transplantation improved patients' self-esteem. There was a trend towards improvement in the social aspect.

Relação entre tratamento protético, autoestima e qualidade de vida em pacientes idosos em tratamento hemodialítico / Relationship between prosthetic treatment, self-esteem and quality of life in elderly patients undergoing hemodialysis

Fundamento: O estado de saúde bucal pode ter influência física e psicológica sobre a vida dos indivíduos. Pode afetar simultaneamente o prazer na vida devido a interferência nas condições bucais, na fala, mastigação, sabor e deglutição, nos domínios sociais, sobre a aparência e autoconfiança dos indivíduos. Objetivo:Verificar se o tratamento protético odontológico é capaz de gerar melhoria na qualidade de vida e na autoestima de pacientes idosos submetidos a hemodiálise. Materiais e Métodos: Realizou-se um estudo intervencional com 26 pacientes submetidos à hemodiálise na cidade de Diamantina, Brasil. Os pacientes foram divididos em dois grupos de acordo com a realização do tratamento; com e sem tratamento. O grupo tratamento recebeu ajustes ou confecção de uma nova prótese odontológica, já o grupo sem tratamento recebeu apenas avaliação clínica e orientações sobre higiene bucal. A qualidade de vida foi avaliada através do instrumento Medical Outcomes Study 36-Item Short Form Health Questionnaire (SF-36) e Oral Health Impact Profile (OHIP) na sua versão 14. Já para a autoestima utilizou-se a Escala de Autoestima de Rosenberg. Resultados: A média de idade foi 69,08 anos (±05,90) e o índice CPO-D médio foi de 29,65 (±01,35). Houve significância estatística na dimensão aspecto emocional do SF-36 nos dois grupos. O grupo que recebeu tratamento apresentou significância na incapacidade física do OHIP-14 e melhora da autoestima. Conclusão: O tratamento protético odontológico gerou melhoria na qualidadede vida e impactou na autoestima de pacientes idosos submetidos à hemodiálise, sendo o impacto maior nos pacientes que realizaram tratamento protético

Background: Oral health status can have a physical and psychological influence on individuals' lives. It can simultaneously affect the pleasure in life due to interference in oral conditions, speech, chewing, taste and swallowing, in social domains, on the appearance and self-confidence of individuals. Objective:To verify whether dental prosthetic treatment is able to improve the quality of life and self-esteem of elderly patients undergoing hemodialysis. Materials and Methods: An interventional study was carried out with 26 patients undergoing hemodialysis in the city of Diamantina, Brazil. Patients were divided into two groups according to treatment completion; with and without treatment. The treatment group received adjustments or made a new dental prosthesis, while the group without treatment received only clinical evaluation and guidance on oral hygiene. Quality of life was assessed using the instrument Medical Outcomes Study 36-Item Short Form Health Questionnaire (SF-36) and Oral Health Impact Profile (OHIP) in its version 14. For self-esteem, the Rosenberg Self-Esteem Scale was used. Results:The mean age was 69.08 years (±05.90) and the mean DMFT index was 29.65 (±01.35). There was statistical significance in the emotional aspect dimension of the SF-36 in both groups. The group that received treatment showed significance in the physical disability of the OHIP-14 and improvement in self-esteem. Conclusion:Dental prosthetic treatment improved the quality of life and impacted the self-esteem of elderly patients undergoing hemodialysis, with the greatest impact on patients who underwent prosthetic treatment.

The reliability and validity of the 30-seconds sit-to-stand test and its capacity for assessment of the functional status of hemodialysis patients.

PURPOSE: To investigate the validity of the 30-seconds sit-to-stand test (STS-30) and its reliability in hemodialysis patients. METHODS: Patients receiving hemodialysis treatment three times a week for at least six months were evaluated using STS-30, Incremental Shuttle Walking Test, and health-related quality of life by KDQOL-SF questionnaire. The data obtained from the Incremental Shuttle Walking Test were divided into tertiles, and the STS-30 results were compared among tertiles. The accuracy of the STS-30 to identify low exercise capacity was evaluated. A second STS-30 was performed after 6 to 8-weeks for the reliability analyses using Intraclass Correlation Coefficient (ICC). Minimal detectable change scores were calculated. RESULTS: Sixty-three individuals (66.7% men) aged 48.3 years (95%CI 44.6-51.9) were evaluated. There were significant correlations between STS-30, exercise capacity (r = 0.72), and physical domains of health-related quality of life (0.30 ≤ r ≤ 0.51). Tertile 1 of the Incremental Shuttle Walking Test was different from tertiles 2 and 3 for STS-30 [difference of 3.4 repetitions (95%CI 1.5-5.4) and 4.7 repetitions (95%CI 2.8-6.7), respectively]. The value of 12 repetitions was the cut-off points for stratification of individuals with low exercise capacity. The STS-30 had a high test-retest reliability (ICC = 0.93) and the minimal detectable change was 2.1 repetitions. CONCLUSION: The STS-30 is a reliable test, associated with exercise capacity and physical domains of health-related quality of life. Thus, is a valid method for functional evaluation in hemodialysis patients.

Influence of dental treatment on quality of life and self-esteem of hemodialysis-therapy patients

Background: Patients undergoing dialysis treatment have a worse quality of life and have higher rates of malnutrition, inflammation and hospitalization than the general population. Objective: This study aimed to evaluate the influence of dental treatment on the quality of life and self-esteem of hemodialysis-therapy patients. Materials and Methods: An interventional study was developed with 27 patients undergoing hemodialysis in Diamantina, Brazil. Initially, patients received a clinical evaluation of a dentist and responded to questionnaires to estimate the quality of life (Medical Outcomes Study 36-Item Short Form Health Questionnaire (SF-36) and Oral Health Impact Profile (OHIP) version 14) and self-esteem (Scale Self-Esteem of Rosenberg). After 45 days, the questionnaires were reapplied, and the patients received dental treatment to adapt the oral environment. After the treatment, 45 days were awaited to reapply the questionnaires. Descriptive analyzes were performed, Wilcoxon and Friedman tests were done. The level of significance was set at 5% (p <0.05). Results: Twenty-seven low-income and educated individuals participated in the study, most of whom were men. Hypertension and diabetes were not widely reported systemic diseases. There was statistical significance in SF-36 and OHIP-14 dimensions and improvement of self-esteem. Conclusion: Dental treatment interfered positively with the quality of life and self-esteem of patients undergoing hemodialysis.

Effects of the inspiratory muscle training and aerobic training on respiratory and functional parameters, inflammatory biomarkers, redox status and quality of life in hemodialysis patients: A randomized clinical trial.

OBJECTIVE: Evaluate and compare the isolated and combined effects of Inspiratory Muscle Training (IMT) and Aerobic Training (AT) on respiratory and functional parameters, inflamatory biomarkers, redox status and health-related quality of life (HRQoL) in hemodialysis patients. METHODS: A randomised controlled trial with factorial allocation and intention-to-treat analysis was performed in hemodialysis patients. Volunteers were randomly assigned to performe 8-weeks of IMT at 50% of maximal inspiratory pressure (MIP), low intensity AT or combined training (CT). Before the interventions, all the volunteers went 8-weeks through a control period (without training). Measures are taken at baseline, 8-week (after control period) and 16-week (after the interventions). Primary outcomes were functional capacity (incremental shuttle walk test), MIP and lower limbs strength (Sit-to-Stand test of 30 seconds). Plasma levels of interleukin-6 (IL-6), soluble tumor necrosis factor receptor 1 (sTNFR1) and 2 (sTNFR2), adiponectin, resistin and leptin, redox status parameters and HRQoL (KDQOL-SF questionnaire) were the scondary outcomes. Data analyses were performed by two-way repeated measurements ANOVA. RESULTS: 37 hemodialysis patients aged 48.2 years old (IC95% 43.2-54.7) were randomized. Increase of MIP, functional capacity, lower limbs strength and resistin levels, and reduction of sTNFR2 levels in 16-week, compared to baseline and 8-week, were observed in all the groups (p<0.001). IMT improved functional capacity, MIP and lower limbs strength in 96.7m (IC95% 5.6-189.9), 34.5cmH2O (IC95% 22.4-46.7) and 2.2repetitions (IC95% 1.1-3.2) respectively. Increase in resistin leves and reduction in sTNFR2 leves after IMT was 0.8ng/dL (IC95% 0.5-1.1) and 0.8ng/dL (IC95% 0.3-1.3), respectively, without between-group differences. Compared to baseline and 8-week, adiponectin levels (p<0.001) and fatigue domain of the HRQoL (p<0.05) increased in 16-week only in CT. CONCLUSION: IMT, AT and CT improved functional parameters and modulated inflammatory biomarkers, in addition, IMT provoked a similar response to low intensity AT in hemodialysis patients. TRIAL REGISTRATION: Registro Brasileiro de Ensaios clínicos RBR-4hv9rs.

The role of the inspiratory muscle weakness in functional capacity in hemodialysis patients.

INTRODUCTION: Inspiratory muscle function may be affected in patients with End-Stage Renal Disease (ESRD), further worsening the functional loss in these individuals. However, the impact of inspiratory muscle weakness (IMW) on the functional capacity (FC) of hemodialysis patients remains unknown. Thus, the present study aimed to evaluate the impact of IMW on FC in ESRD patients undergoing hemodialysis. MATERIALS AND METHODS: ESRD patients on hemodialysis treatment for more than six months were evaluated for inspiratory muscle strength and FC. Inspiratory muscle strength was evaluated based on maximal inspiratory pressure (MIP). IMW was defined as MIP values less than 70% of the predicted value. FC was evaluated using the Incremental Shuttle Walk test (ISWT). Patients whose predicted peak oxygen uptake (VO2peak) over the distance walked during the ISWT was less than 16mL/kg/min were considered to have FC impairment. Associations between variables were assessed by linear and logistic regression, with adjustment for age, sex, body mass index (BMI), presence of diabetes and hemoglobin level. Receiver-operating characteristic (ROC) analysis was used to determine different cutoff values of the MIP for normal inspiratory muscle strength and FC. RESULTS: Sixty-five ERSD patients (67.7% male), aged 48.2 (44.5-51.9) years were evaluated. MIP was an independent predictor of the distance walked during the ISWT (R2 = 0.44). IMW was an independent predictor of VO2peak < 16mL/kg/min. (OR = 5.7; p = 0.048) in adjusted logistic regression models. ROC curves showed that the MIP cutoff value of 82cmH2O had a sensitivity of 73.5% and specificity of 93.7% in predicting normal inspiratory strength and a sensitivity and specificity of 76.3% and 70.4%, respectively, in predicting VO2peak ≥ 16mL/kg/min. CONCLUSIONS: IMW is associated with reduced FC in hemodialysis patients. Evaluation of the MIP may be important to functional monitoring in clinical practice and can help in the stratification of patients eligible to perform exercise testing.

Correlation between indexes of autonomic maneuvers and heart rate variability in hemodialysis patients.

PURPOSE: The autonomic maneuvers are simple methods to evaluate autonomic balance, but the association between autonomic maneuvers and heart rate variability (HRV) in hemodialysis patients remains unknown. This study aimed to evaluate the correlation between HRV and respiratory sinus arrhythmia (RSA) and Valsalva maneuver (VM) indexes in hemodialysis patients and to compare two methods for RSA indexes acquisitions. METHODS: Forty-eight volunteers on hemodialysis (66.7 % men) were evaluated by VM, RSA, and 24 h Holter monitoring. At the VM, the Valsalva index (VI) was the variable considered. In the RSA, the ratio and difference between the RR intervals of inspiratory and expiratory phase (E:I and E-I, respectively) were considered by traditional form (average of respiratory cycles) and independent respiratory cycles (E:Iindep and E-Iindep). The HRV indexes evaluated were standard deviation of all normal RR intervals (SDNN), standard deviation of sequential 5-min RR interval means (SDANN), root mean square of the successive differences (rMSSD) and percentage of adjacent RR intervals with difference of duration greater than 50 ms (pNN50). RESULTS: The SDNN, SDANN showed significant correlation with all classic indexes of RSA (E:I: r = 0.62, 0.55, respectively, E-I: r = 0.64, 0.57, respectively), E:Iindep (r = 0.59, 0.54, respectively), E-Iindep (r = 0.47, 0.43, respectively) and VI (r = 0.42, 0.34, respectively). Significant correlation of rMSSD with E:I (r = 0.37), E-I (r = 0.41) and E:Iindep (r = 0.34) was also observed. There was no association of any variable with pNN50. Have been show high values for all variables of independent cycles method (p < 0.05). CONCLUSION: The autonomic maneuvers, especially RSA, are useful methods to evaluate cardiac autonomic function in hemodialysis patients. The acquisition of the RSA index by independent cycles should not be used in this population.

Lesões supurativas intracranianas / Intracranial suppurative lesions

Este artigo apresenta revisão sobre as lesões supurativas intracranianas. A maioria dessas afecções são resultado de infecções, traumas ou cirurgias. Os pacientes geralmente manifestam um largo espectro de sintomas inespecíficos, o que exige alto grau de suspeição. Exames de imagem são indispensáveis para confirmação do diagnóstico. O tratamento se baseia em antibioticoterapia intensiva e abordagem neurocirúrgica. Diagnóstico precoce e tratamento agressivo são essenciais para um bom prognóstico.

Presents review of Intracranial Suppurative Lesions. These affections are consequence of infections, trauma or surgery. Patients usually manifest a large unspecific spectrum of clinical symptoms, so, a high level of suspicion is required. Imaging exams are indispensable to confirm the diagnosis. The treatment is based on intensive antibiotic therapy and surgical evacuation. Early diagnosis with aggressive medical and surgical management are essential to improved outcome.

Complicações intracranianas de rinossinusite / Intracranials complications of rhinosinusitis

Apresenta-se caso de abscesso epidural intracraniano associado a um empiema subdural como complicações de rinossinusite. O diagnóstico foi feito pela clínica em conjunto com a tomografia computadorizada. O paciente foi tratado com antibioticoterapia tríplice e intervenção cirúrgica para drenagem de empiema, evoluindo para a cura.

Report a case of intracranial epidural abscess associated with subdural empyema as a complication of a rhinosinusitis. The diagnosis was made by the clinical course and computerized tomography. The patient was treated with antibiotic therapy of wide spectrum and surgical treatment to drain the empyema, going to cure.