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

{"title":"Association between obstructive sleep apnea and cardiovascular events in hemodialysis patients.","authors":"Ellen Goes, Skarllet Cândida Silva Santos, Rodrigo Bezerra, Flávio Teles","doi":"10.1590/2175-8239-JBN-2025-0123en","DOIUrl":"10.1590/2175-8239-JBN-2025-0123en","url":null,"abstract":"<p><strong>Introduction: </strong>Hemodialysis patients are at high cardiovascular risk, with sudden death being one of the leading cause of mortality. Sleep disorders are highly prevalent in this population, and obstructive sleep apnea (OSA) has been associated with poorer blood pressure control and cardiovascular damage.</p><p><strong>Objective: </strong>To investigate the association between an intermediate or high risk of OSA and the occurrence of major cardiovascular events in hemodialysis patients.</p><p><strong>Methods: </strong>This prospective multicenter cohort study was conducted in three hemodialysis clinics between May 2022 and May 2024. A total of 165 patients aged 18 to 75 years who had been undergoing hemodialysis for at least 6 months were included. Clinical, labora-tory, and sleep-related variables, were assessed, including OSA risk (STOP-Bang), sleep quality (Pittsburgh Sleep Quality Index), chronotype (Morningness-Eveningness Questionnaire), and the occurrence of major adverse cardiovascular events (MACE+). Patients were followed for 22 to 24 months.</p><p><strong>Results: </strong>Overall 64.8% of patients were classified as being at an intermediate or high risk for OSA. This group showed a higher prevalence of diabetes and obesity, poorer sleep quality, more cases of chronic restless legs syndrome, and lower dialysis adequacy. The incidence of major cardiovascular events was significantly higher among patients at risk of OSA (17.0% vs. 5.2%; p = 0.03), with an independent association observed between OSA and sudden death (OR 1.18, 95% CI 1.01-1.39; p = 0.03). Other sleep disorders were not associated with increased cardiovascular risk.</p><p><strong>Conclusion: </strong>Hemodialysis patients had a high risk of OSA, which was independently associated with adverse cardiovascular outcomes.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 4","pages":"e20250123"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186011","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}

{"title":"Effectiveness of steroid-free immunosuppressive regimens after kidney transplantation: the pioneering experience of a brazilian center.","authors":"Tainá Veras de Sandes-Freitas, Flávio Bezerra de Araújo, Raoni de Oliveira Domingues-da-Silva, Maria Luíza de Mattos Brito Oliveira Sales, Ronaldo de Matos Esmeraldo","doi":"10.1590/2175-8239-JBN-2025-0062en","DOIUrl":"10.1590/2175-8239-JBN-2025-0062en","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic corticosteroid use, even at low doses, is associated with well-known adverse effects. However, steroid-free regimens after kidney transplantation (KT) have been linked to a higher incidence of acute rejection (AR), limiting their implementation to a few centers worldwide. In this study, we describe the pioneering experience of a Brazilian center that adopted a steroid-free immunosuppressive regimen in 2005 for patients at low to moderate immunological risk.</p><p><strong>Methods: </strong>This single-center retrospective cohort study includes KT recipients who were submitted to steroid-free regimens between 2012 and 2019. The cohort was followed for three years in a real-world setting.</p><p><strong>Results: </strong>A total of 562 patients were included, 71.4% male, with a median age of 48.1 years (IQR 35.5-58.6). Most (95.2%) received deceased donor allografts. All patients underwent induction therapy with antithymocyte globulin, and 82.2% received tacrolimus in combination with sirolimus or everolimus as maintenance therapy. After three years, 10.2% experienced treated AR episodes, with biopsy confirmation in 3.2%. Age (HR 0.946, 95% CI 0.923-0.969, p < 0.001) and HLA mismatches (HR 1.312, 95% CI 1.021-1.687, p = 0.034) were risk factors for rejection. Twenty-eight patients (5%) lost their grafts, and 5.7% died. Seventy-one patients (12.6%) required corticosteroid introduction over the years, with a median of 125.5 days (IQR 31.7-409) post-KT. The main reasons were perceived immunosuppressive regimen inefficacy (56.3%) and composition in a low-efficacy immunosuppressive regimen (18.6%).</p><p><strong>Conclusion: </strong>Steroid-free immunosuppression was effective in low to moderate immunological risk KT recipients over a three-year follow-up period.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 4","pages":"e20250062"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149161","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}

{"title":"Rituximab in primary podocytopathies: efficacy and safety in a retrospective cohort.","authors":"Gabriel Teixeira Montezuma Sales, Danilo Euclides Fernandes, Gianna Mastroianni Kirsztajn","doi":"10.1590/2175-8239-JBN-2025-0120en","DOIUrl":"10.1590/2175-8239-JBN-2025-0120en","url":null,"abstract":"<p><strong>Introduction: </strong>Podocytopathies are an important cause of nephrotic syndrome, and immunosuppression plays a pivotal role in disease management. The efficacy of biological agents such as rituximab (RTX), however, remains unclear, especially in adults. This study hypothesized that RTX is efficient and safe in the treatment of steroid-sensitive and steroid-resistant primary podocytopathies.</p><p><strong>Method: </strong>A retrospective cohort study was conducted based on medical records before the first infusion of RTX (T0) and 1 to 3 months (T1) and 3 to 6 months after infusion (T2). Patients had biopsy-proven podocytopathies and received at least 500 mg of RTX. Individuals with secondary glomerular diseases were excluded.</p><p><strong>Results: </strong>A total of 31 patients with a mean age at infusion of 32.9 years (SD 11.0) were included. At T2, remission was reached in 45.2%, with complete remission in 19.4%. Prior response to steroids was related to a better prognosis, with remission in up to 68.5% of these patients. Moreover, 20.0% of steroid-resistant patients reached adapted remission (≥ 35% proteinuria decrease + ≥ 20% serum albumin increase). Hypertension and previous use of calcineurin inhibitors were not predictors of clinical response. The most frequent adverse events were infection (12.9%) and rash (9.7%).</p><p><strong>Discussion: </strong>In conclusion, our results suggest that RTX is a useful therapeutic option not only for steroid-sensitive podocytopathies, but also in selected steroid-resistant cases, determining a proteinuria decrease that can contribute positively to the clinical management of such glomerular diseases. RTX was generally efficient and well tolerated in this adult cohort.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 4","pages":"e20250120"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185945","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}

{"title":"Influence of albumin and phase angle on the survival of patients with chronic kidney disease on hemodialysis: a prospective study.","authors":"Alain León Sáez, Joane Severo Ribeiro, Camila Nery Silva, Cristiane Bündchen, Elizete Keitel, Gilson Pires Dorneles, Catarina Bertaso Andreatta Gottschall, Alessandra Peres","doi":"10.1590/2175-8239-JBN-2024-0207en","DOIUrl":"10.1590/2175-8239-JBN-2024-0207en","url":null,"abstract":"<p><strong>Introduction: </strong>Hemodialysis (HD) prolongs the survival of patients with end-stage chronic kidney disease (CKD), but mortality remains high due to malnutrition and inflammation. This study aimed to investigate whether low albumin levels and a reduced phase angle (PA) predict higher mortality in HD patients.</p><p><strong>Methods: </strong>This prospective cohort study followed 82 HD patients for 36 months. Biological markers, including albumin and oxidative stress indicators, were measured before and after a single HD session upon study enrollment (time zero). PA was determined by bioimpedance analysis. Kaplan-Meier survival curves and Cox regression analyses were performed to assess the association between albumin, PA, and mortality.</p><p><strong>Results: </strong>Patients with PA <4 had a mean survival of 11.6 months, compared to 27.0 months for those with PA ≥ 4 (HR = 5.66; 95% CI: 2.44-13.12). Similarly, patients with albumin <3.9 g/dL had significantly lower survival rates at 6, 12, and 36 months compared to those with albumin ≥3.9 g/dL (HR = 4.39; 95% CI: 1.81-10.63).</p><p><strong>Conclusion: </strong>Low albumin levels and a reduced PA are strong predictors of mortality in HD patients. Routine monitoring and targeted interventions to improve these markers could enhance survival outcomes.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 4","pages":"e20240207"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185988","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}

{"title":"Early prediction matters: renal biomarkers in coronary artery bypass grafting.","authors":"Renata de Souza Mendes","doi":"10.1590/2175-8239-JBN-2025-E011en","DOIUrl":"10.1590/2175-8239-JBN-2025-E011en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 3","pages":"e2025E011"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682634","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}

{"title":"Unmasking the presentation of AKD in COVID-19.","authors":"Mauricio Younes-Ibrahim","doi":"10.1590/2175-8239-JBN-2025-E010en","DOIUrl":"10.1590/2175-8239-JBN-2025-E010en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 3","pages":"e2025E010"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873244","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}

{"title":"Assessing kidney donor quality: the saga continues.","authors":"Tainá Veras de Sandes-Freitas","doi":"10.1590/2175-8239-JBN-2025-E013en","DOIUrl":"10.1590/2175-8239-JBN-2025-E013en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 3","pages":"e2025E013"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715072","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}

{"title":"From Brazil to the world: a journal with purpose.","authors":"José A Moura-Neto, Thyago Proença de Moraes, Miguel Carlos Riella","doi":"10.1590/2175-8239-JBN-2025-E015en","DOIUrl":"10.1590/2175-8239-JBN-2025-E015en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 3","pages":"e2025E015"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682635","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}

{"title":"Academic and professional profile and impact of graduates from the Nephrology Graduate Program at UNIFESP.","authors":"Pablo Ferraz, Nestor Schor, Gianna Mastroianni Kirsztajn","doi":"10.1590/2175-8239-JBN-2024-0178en","DOIUrl":"10.1590/2175-8239-JBN-2024-0178en","url":null,"abstract":"<p><strong>Introduction: </strong>Graduate studies in Brazil have experienced significant growth since the 1990s. Over a 40-year period, the Graduate Program in Nephrology at Unifesp has qualified 261 master's graduates, 111 doctors and 146 individuals who completed both a master's and a doctoral degree. Of these, 278 hold a degree in Medicine. Medical postgraduates were responsible for 124 master's dissertations and 243 doctoral theses completed.</p><p><strong>Objective: </strong>This study analyzed the profile and professional trajectories of graduate students from the Nephrology Graduate Program at Unifesp.</p><p><strong>Methods: </strong>The authors used the university's database to establish the graduates' profile and applied a questionnaire to identify their professional performance in academia and the job market. The graduates were divided into three groups: G1 - 1976 to 1997 (N = 127); G2 - 1998 to 2006 (N = 150); G3 - 2007 to 2015 (N = 241).</p><p><strong>Results: </strong>Regarding sex, male medical graduates were responsible for 53.6% of all completion papers; however, in the most recent period, women accounted for 61% of the works. Female participation was consistently higher among graduates from other areas, at 73.8% of the total. Among the physicians, 65.5% graduated from public universities, with the first group standing out with 73%. In the other groups, 59.5% and 59.8% came from public HEIs, respectively. The overall average income reported by master's graduates responding to the questionnaire ranged from 5 to 10 minimum wages (MW), and for doctors, above 10 MW.</p><p><strong>Conclusion: </strong>Doctoral graduates had a strong presence in academia, predominantly within the public sector.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 3","pages":"e20240178"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636994","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}

{"title":"Optic nerve sheath calcification in a patient with chronic kidney disease: an unusual orbital manifestation.","authors":"Lara Hemerly De Mori, Nina Ventura, Diogo Goulart Corrêa","doi":"10.1590/2175-8239-JBN-2025-0085en","DOIUrl":"10.1590/2175-8239-JBN-2025-0085en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 3","pages":"e20250085"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528039","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}