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

{"title":"Recommendations of the Brazilian Society of Nephrology for regulating access to outpatient dialysis in the Brazilian Unified Health System.","authors":"Farid Samaan, Fernanda Salomão Gorayeb-Polacchini, Alexandre Minetto Brabo, Paulo Henrique Fraxino, Fábio Humberto Ferraz, Ana Lydia Lédo de Castro Ribeiro Cabeça, René Scalet Dos Santos Neto, Patrícia Ferreira Abreu, José A Moura-Neto","doi":"10.1590/2175-8239-JBN-2025-0261en","DOIUrl":"10.1590/2175-8239-JBN-2025-0261en","url":null,"abstract":"<p><p>The increase in chronic kidney disease prevalence and its risk factors have pressured universal health systems to expand the supply of kidney replacement therapy (KRT - hemodialysis, peritoneal dialysis and kidney transplantation). Particularly in low- and middle-income countries and those undergoing a fast epidemiological and demographic transition, the access to nephrology consultations and multidisciplinary care is limited, and the majority of patients start KRT in an unplanned manner or during emergency hospitalization. Even patients with adequate pre-dialysis care and elective requests for KRT are at risk of clinical decompensation and requiring hospitalization to start emergency dialysis; this risk increases the longer the delay in starting KRT. In both cases, the patient's access to an outpatient dialysis unit must be timely and the transition of care safe. There are Brazilian and international guidelines for patients who are prevalent on dialysis. However, there are no clear recommendations for regulating access to the start of outpatient KRT, which often leads to divergent opinions among healthcare professionals and contributes to the inefficiency of the regulatory process. This document aims to: (1) list the main challenges in the daily practice of the regulatory professionals in the Brazilian Unified Health System; (2) present recommendations from the Brazilian Society of Nephrology based on scientific evidence and available legislation.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e20250261"},"PeriodicalIF":1.3,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12904151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142506","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":"The role of probiotics in modulating the gut microbiota as a potential inhibitor of diabetic kidney disease progression.","authors":"Vitoria Cecilia Souza Costa, Monique Moreira Pinheiro, Giulia Triolo Cabreira, Isabella Bacci Bustelli, Julia Ferreira Santos, Sara Ventura, Luciana Soares Costa Santos, Maria de Fatima Fernandes Vattimo, Eloiza de Oliveira Silva","doi":"10.1590/2175-8239-JBN-2025-0143en","DOIUrl":"10.1590/2175-8239-JBN-2025-0143en","url":null,"abstract":"<p><strong>Introduction: </strong>Gut dysbiosis is commonly observed in patients with diabetic kidney disease (DKD) and may contribute to its pathogenesis. Among microbial metabolites, butyrate plays a key role in regulating antioxidant proteins in type 2 diabetes mellitus (T2DM). Based on this, we hypothesized that the administering probiotics to diabetic rats modulates redox status and thereby attenuates renal disease progression.</p><p><strong>Methods: </strong>An in vivo study was performed using 15 male Wistar rats (8 weeks old, 250-300 g) randomized into three groups (n = 5/group): Control (vehicles: 0.9% saline and 0.1 M citrate, pH 4.2, i.p., on day 1), T2DM (nicotinamide 100 mg/kg, i.p., followed by streptozotocin 60 mg/kg, i.p., in 0.1 M citrate buffer, pH 4.2), and T2DM + Prob (T2DM protocol plus a multistrain probiotic-Bifidobacterium longum, Bifidobacterium bifidum, and Lactobacillus rhamnosus-1010 CFU/mL by gavage for 6 weeks). The parameters evaluated were: serum creatinine, inulin clearance, microalbuminuria, urinary and lipid peroxides, glutathione, and nuclear factor erythroid 2-related factor 2 (Nrf2).</p><p><strong>Results: </strong>Probiotic treatment significantly increased Nrf2 expression and glutathione levels, reduced urinary and lipid peroxidation, and-beyond attenuating oxidative stress-improved renal function, with lower serum creatinine and microalbuminuria and higher inulin clearance.</p><p><strong>Conclusion: </strong>These findings indicate that probiotics prevented DKD progression, likely by modulating oxidative stress via the gut microbiota. These results suggest that probiotics may serve as renoprotective agents, potentially reducing DKD morbidity in T2DM.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 2","pages":"e20250143"},"PeriodicalIF":1.3,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12797498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959269","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":"Novel biomarkers for CKD risk stratification: a literature review.","authors":"Sariya Khan, Aleena Zobairi, Elaf Rehan, Ashraf Hussein Mohammed","doi":"10.1590/2175-8239-JBN-2025-0109en","DOIUrl":"10.1590/2175-8239-JBN-2025-0109en","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease (CKD) is a progressive illness with high morbidity and mortality that warrants early and accurate risk stratification for optimal management. The traditional biomarkers, serum creatinine and estimated glomerular filtration rate (eGFR), are insufficient for detecting early CKD and long-term prognosis. Novel biomarkers have emerged as effective tools to complement CKD diagnosis, prognosis, and therapeutic monitoring.</p><p><strong>Aim: </strong>The aim of this research was to determine the potential of novel biomarkers in CKD risk stratification and their clinical significance for improving early detection, monitoring disease progression, and developing individualized treatment strategies.</p><p><strong>Methods: </strong>A literature review was conducted by searching the PubMed, Scopus, and Embase databases to identify studies on novel CKD biomarkers, including cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and specific microRNAs.</p><p><strong>Results: </strong>Emerging evidence suggests that novel biomarkers provide superior predictive abilities compared to traditional markers. Cystatin C is more accurate in kidney function estimation, whereas NGAL and KIM-1 are markers of early kidney injury. MicroRNAs show potential in distinguishing between CKD subtypes and predicting disease progression. Clinical application of these biomarkers may enhance CKD risk stratification, allowing more targeted intervention strategies.</p><p><strong>Conclusion: </strong>New biomarkers in CKD risk stratification represent a watershed moment in nephrology, offering improved early detection and prognostic accuracy. While promising, additional large-scale research and clinical validation are required before they can be used routinely.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e20250109"},"PeriodicalIF":1.3,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12788398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933400","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":"Maintenance of inequity in the provision of chronic dialysis treatment in Brazil.","authors":"Fábio Humberto Ribeiro Paes Ferraz, Cibele Isaac Saad Rodrigues, Natan Monsores de Sá","doi":"10.1590/2175-8239-JBN-2025-0033en","DOIUrl":"10.1590/2175-8239-JBN-2025-0033en","url":null,"abstract":"<p><strong>Introduction: </strong>The high rate of people with chronic kidney disease on dialysis is a public health problem, especially in developing countries.</p><p><strong>Objectives: </strong>To evaluate demographic and socioeconomic changes related to dialysis treatment in Brazil from 2002 to 2019.</p><p><strong>Methods: </strong>This descriptive, analytical study reviewed retrospective documentary data. A comparative analysis was conducted on demographic, economic, and social trends, as well as changes in dialysis service provision in Brazil between 2002 and 2019. Correlation analysis between Municipal Human Development Index (HDI-M) and the number of dialysis units was performed.</p><p><strong>Results: </strong>There was an increase in the percentage of the older population (5.3% vs. 9.25%) and in life expectancy at birth (70.8 vs. 75.9 years). The gross domestic product (GDP) increased by 453%; the percentage of investment in public health (below 4%) was stable and the ranking of global Human Development Index decreased (73 vs 84). The increase in the prevalence of patients on chronic maintenance dialysis was greater than the increase in the number of patients in new centers (117.3% vs. 43.9%), with fewer patients receiving treatment in the North and Northeast regions. There was a positive linear correlation between the HDI-M values and the number of dialysis units (R = 0.52; 95% CI: 0.75-0.18; p = 0.006).</p><p><strong>Conclusion: </strong>Despite Brazil's strong economic growth and the drastic demographic changes that occurred during the study period, this progress did not translate into a higher investment in health and equitable access to dialysis treatment across the country.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e20250033"},"PeriodicalIF":1.3,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12788823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793986","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":"Kidney Paired Donation (KPD) in Brazil: first 3-way case report.","authors":"Juliana Bastos, Glaucio Silva de Souza, Marcio Luiz de Sousa, Pedro Bastos Guimarães de Almeida, Thais Freesz, David Jose de Barros Machado, Elias David-Neto, Gustavo Fernandes Ferreira","doi":"10.1590/2175-8239-JBN-2025-0177en","DOIUrl":"10.1590/2175-8239-JBN-2025-0177en","url":null,"abstract":"<p><p>Kidney Paired Donation (KPD) is a transformative strategy in living kidney donor transplantation (LDKT), particularly for overcoming immunological barriers that preclude direct donation. In 2021, KPD accounted for one-fifth of adult LDKT and for half of LDKT for sensitized recipients in the United States. In Brazil, with a high prevalence of chronic kidney disease (CKD) and over 30,000 patients on transplant waiting lists, the demand for compatible donors far exceeds supply. This article presents a case report of KPD in the Brazilian context, illustrating its feasibility and highlighting challenges and considerations for broader implementation. The case demonstrates KPD's potential to increase transplant rates, improve outcomes, and reduce dialysis costs. Nevertheless, structural, ethical, and regulatory challenges remain. This report emphasizes the implications of expanding KPD as a sustainable, life-saving strategy in Brazil.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e20250177"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12965706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369490","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":"Hyponatremia and the risk of Osmotic Demyelination Syndrome: is it time to review sodium correction rates?","authors":"Carlos Perez Gomes","doi":"10.1590/2175-8239-JBN-2026-E005en","DOIUrl":"10.1590/2175-8239-JBN-2026-E005en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e2026E005"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12844543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052185","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":"MicroRNAs and peritoneal dialysis.","authors":"Hugo Abensur","doi":"10.1590/2175-8239-JBN-2026-E001en","DOIUrl":"10.1590/2175-8239-JBN-2026-E001en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e2026E001"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793889","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":"Knowledge gaps in dialysis: from recognition to implementation of intradialytic exercise.","authors":"Fernanda Salomão Gorayeb-Polacchini","doi":"10.1590/2175-8239-JBN-2025-E002en","DOIUrl":"10.1590/2175-8239-JBN-2025-E002en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e2026E002"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12817534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989436","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":"Position Statement of the Brazilian Society of Nephrology on Home Hemodialysis.","authors":"Fernanda Salomão Gorayeb-Polacchini, Dirceu Reis da Silva, Allison Andrade, Isadora Cartaxo de Sousa Calvo, João Cezar Mendes Moreira, José Carolino Divino-Filho, Patrícia Ferreira Abreu, Paulo Henrique Fraxino, Renato Jorge Palmeira de Medeiros, José A Moura-Neto, Rosilene Motta Elias","doi":"10.1590/2175-8239-JBN-2025-0286en","DOIUrl":"10.1590/2175-8239-JBN-2025-0286en","url":null,"abstract":"<p><p>Home hemodialysis (HHD) has been increasingly consolidated worldwide as an effective modality of kidney replacement therapy (KRT), associated with greater autonomy, flexibility, and quality of life for patients, in addition to allowing individualized prescriptions with more frequent and/or longer sessions. Despite evidence demonstrating survival rates equal to or superior to those of in-center hemodialysis, HHD remains underutilized globally, including in Brazil. Limiting factors include structural, logistical, financial, and cultural barriers, as well as the absence of specific national regulations. This document presents the position of the Brazilian Society of Nephrology (SBN) on HHD, establishing recommendations for patient eligibility, home and dialysis center selection criteria, responsibilities, and technical safety requirements. Two HHD models are described: the self-care modality, in which patients perform the treatment on their own after intensive and strict training, and the assisted modality, carried out with the continuous presence of a healthcare professional. The position emphasizes the need for an associated dialysis center, structured training, safety protocols, continuous monitoring, and emergency backup. Key aspects such as water quality, supply chain logistics, waste disposal, and environmental sustainability are considered essential. The SBN advocates that adherence to HHD should result from shared decision-making between patients, families, and the multidisciplinary team, formalized through an informed consent document. This position aims to support policies, adequate funding, and regulatory adjustments to enable the practice of HHD in Brazil, ensuring care quality, equity of access, and the safety of patients and professionals involved.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e20250286"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12904603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146194494","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":"Kinetics of cellular immune response to SARS-CoV-2 vaccine boosters in dialysis and kidney transplant patients without infection.","authors":"Roberto Matias Souza, Julia Soares Reis, Helio Tedesco-Silva, Lúcio Requião-Moura, José Medina-Pestana, Renato Demarchi Foresto","doi":"10.1590/2175-8239-JBN-2025-0206en","DOIUrl":"10.1590/2175-8239-JBN-2025-0206en","url":null,"abstract":"<p><strong>Introduction: </strong>Dialysis patients and kidney transplant recipients (KTRs) present impaired immune response to COVID-19 vaccines. Although vaccination remains the primary strategy to reduce mortality, data on the cellular immune response kinetics in these populations are limited. This study evaluated the kinetics of vaccine-induced cellular immunity to SARS-CoV-2 in dialysis and KTRs without prior infection.</p><p><strong>Methods: </strong>This is a post-hoc analysis of a prospective, observational, single-center study comparing the cellular immunity kinetics induced by SARS-CoV-2 vaccination in adult patients undergoing kidney transplant (n = 77) and patients on dialysis (n = 92). Those who had COVID-19 were excluded. Blood samples were collected at screening and at 1, 3, 6, and 12 months to assess SARS-CoV-2-specific T-cell responses using a commercial Interferon-gamma release assay (IGRA, QuantiFERON SARS-CoV-2 RUO), with results classified as positive, negative, or indeterminate. Comparisons were performed using chi-square and Mann-Whitney tests.</p><p><strong>Results: </strong>Positive IGRA results were infrequent in transplant and dialysis patients over time (Screening: 8.1% vs. 23.2%; M1: 14.1% vs. 16.5%; M3: 10% vs. 7.1%; M6: 1.5% vs. 2.5%; M12: 15.2% vs. 13.4%), but indeterminate results were common (Screening: 82.4% vs. 17.8%; M1: 71.8% vs. 42.4%; M3: 62.9% vs. 47.1%; M6: 69.1% vs. 58.8%; M12: 30.3% vs. 19.4%), particularly among KTRs, although they received more vaccine boosters (95 vs. 63; p < 0.001). No correlation was observed between the number of vaccine doses and IGRA positivity.</p><p><strong>Conclusion: </strong>Despite multiple vaccine boosters, dialysis and kidney transplant patients exhibited limited and variable cellular immune responses, highlighting the need for improved vaccination and monitoring strategies in these high-risk populations.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e20250206"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503882","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}