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

{"title":"Overcorrection of severe hyponatremia, osmotic demyelination syndrome, and mortality: insights from two Brazilian centers.","authors":"Lívia de Azevêdo Cerqueira Reis, Maria Gabriela Motta Guimarães, Ananda Pires Bastos, Dyonatas Rodrigues da Mata, Daniel Henrique Lins E Silva, Paulo Novis Rocha","doi":"10.1590/2175-8239-JBN-2025-0161en","DOIUrl":"10.1590/2175-8239-JBN-2025-0161en","url":null,"abstract":"<p><strong>Introduction: </strong>Severe hyponatremia (sodium ≤ 120 mmol/L) poses significant clinical risks, including encephalopathy and seizures, but inadvertent rapid correction may cause osmotic demyelination syndrome (ODS). Current guidelines recommend limiting sodium correction to ≤8 mmol/L per 24 hours to minimize ODS risk. However, recent studies suggest that overcorrection may not directly contribute to mortality and could even be associated with improved outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included 362 patients with severe hyponatremia admitted to two Brazilian tertiary hospitals. Overcorrection was defined as a serum sodium increase >8 mmol/L in 24 hours or >18 mmol/L in 48 hours. Multivariate logistic regression and propensity score-weighted analyses were used to identify predictors and outcomes associated with overcorrection.</p><p><strong>Results: </strong>Overcorrection occurred in 38.7% of patients whereas ODS occurred in only one patient (0.28%). Independent predictors of overcorrection included younger age, lower admission sodium levels, and higher volumes of 0.9% NaCl administered in the emergency room; cancer diagnosis and furosemide use were protective factors. Overcorrection was associated with lower in-hospital mortality and shorter hospital stays, even in propensity score-weighted multivariate analyses. However, a detailed review of mortality cases revealed no direct causal link between the rate of sodium correction and death.</p><p><strong>Conclusion: </strong>Overcorrection of severe hyponatremia was common and associated with better clinical outcomes, without a significant increase in the risk of ODS. However, given the observational nature of this association, randomized controlled trials are needed before the current guidelines for correction rate can be reconsidered.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e20250161"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052201","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":"Errata: I Diretriz Brasileira de hipertensão arterial na diálise da Sociedade Brasileira de Nefrologia.","authors":"","doi":"10.1590/2175-8239-JBN-2024-0033er","DOIUrl":"10.1590/2175-8239-JBN-2024-0033er","url":null,"abstract":"<p><p>[This corrects the article doi: 10.1590/2175-8239-JBN-2024-0033pt].</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e20240033er"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12904328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146194477","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":"Prof. Artur Beltrame Ribeiro: a life devoted to making new friends until the very end.","authors":"José Medina Pestana, Lúcio Requião-Moura","doi":"10.1590/2175-8239-JBN-2026-IM01en","DOIUrl":"10.1590/2175-8239-JBN-2026-IM01en","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":"e2026IM01"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355105","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":"Improvement in kidney function in patients with chronic hepatitis B and chronic kidney disease after switching to tenofovir alafenamide fumarate: a systematic review with single arm meta-analysis.","authors":"João Galdino de Pascoa Junior, Ramon Huntermann, Victor Machado Viana Gomes, Frederico de Sousa Marinho Mendes Filho, João Marcelo Vallim Bertozzi, Paulo Ricardo Gessolo Lins","doi":"10.1590/2175-8239-JBN-2025-0193en","DOIUrl":"10.1590/2175-8239-JBN-2025-0193en","url":null,"abstract":"<p><strong>Introduction: </strong>Tenofovir disoproxil fumarate (TDF) is effective in treating hepatitis B virus, (HBV) but has been associated with nephrotoxicity. In contrast, tenofovir alafenamide fumarate (TAF) has emerged as a safer alternative, reducing kidney exposure while maintaining antiviral efficacy. This meta-analysis evaluates improvements in kidney function following the switch from TDF to TAF.</p><p><strong>Methods: </strong>Our study was registered in PROSPERO (CRD42024565358) and included 10 randomized controlled trials (RCTs) involving 1,179 patients with chronic kidney disease (CKD). We compared renal function before and after switching to TAF.</p><p><strong>Results: </strong>Significant improvements in glomerular filtration rate (GFR) were observed, indicating enhanced kidney function post-switch. The findings confirm that TAF has a superior renal safety profile compared to TDF, particularly in long-term treatments.</p><p><strong>Conclusion: </strong>The clinical relevance of TAF for HBV patients with CKD aligns with current guideline shifts favoring TAF. Despite limitations such as high heterogeneity, this study supports TAF as a safer management strategy for HBV patients with CKD, demonstrating improved kidney outcomes and reduced nephrotoxicity risks. These findings support its broader use in clinical practice and highlight the need for further research on long-term renal outcomes.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e20250193"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12788822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145944321","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":"EPI-CKD Brazil: point-of-care screening for chronic kidney disease during World Kidney Day.","authors":"Viviane Calice-Silva, Patrícia Abreu, Maria Eliete Pinheiros, Ana Katarina Cerqueira Delgado Lopes, Karla Cristina Petruccelli, Ana Wanda Barreto Marinho, Ana Flávia Moura, Felipe Costa Neves, Cláudia Maria Costa Oliveira, Silvana Daher Costa, Luiz Roberto Sousa Ulisses, Fábio Humberto Ribeiro Paes Ferraz, Ramiele Aparecida Cruz Souza, Rachel Gatti Armani, Ciro Bruno Costa, Marcelo Garcia Tavares, Dyego José Araújo Brito, Erika Cristina Ribeiro Lima Carneiro, Luiz Gonzaga Filho, Jenaine Oliveira Paixão, Helady Sanders-Pinheiro, Luis Claudio Santos Pinto, Lucas Acatauassu Nunes, Pablo Rodrigues Costa Alves, Amanda Maíra Damasceno Silva, René Scalet Santos Neto, Suzana Ricardo Greffin, Gisele Vajgel, João Marcelo Medeiros Andrade, Ginivaldo Victor Ribeiro Nascimento, Igor Denizarde Bacelar Marques, Maria Izabel Holanda, Pedro Tulio Monteiro Castro Abreu Rocha, Kalyanne Cabral de Paula O, Lelyanne Rodrigues Pereira Torauato, Cristina Karohl, Juliana Alves Manhaes Andrade, Ariane Karen Sousa, Denise Rodrigues Simão, Ana Carolina Nakamura Tome, Daniela Ponce, Fernanda Salomão Gorayeb-Polacchini, Maria Almerinda Vieira Fernandes Ribeiro Alves, Rubens Escobar Pires Lodi, Cinthia Montenegro, José A Moura-Neto","doi":"10.1590/2175-8239-JBN-2025-0298en","DOIUrl":"https://doi.org/10.1590/2175-8239-JBN-2025-0298en","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease (CKD) is a public health issue, with an estimated prevalence of 10% in Brazil, possibly underestimated due to regional inequalities and diagnostic limitations. The EPI-CKD Brazil study aimed to estimate the prevalence of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 in adults with risk factor for CKD, using point-of-care creatinine testing (POCTcr) during World Kidney Day 2025, and to assess regional variations and associated predictors.</p><p><strong>Methods: </strong>We conducted a multicenter cross-sectional study across 20 state chapters of the Brazilian Society of Nephrology, including individuals ≥ 18 years with at least one CKD risk factor (age > 60 years, hypertension [HTN], diabetes mellitus [DM], cardiovascular disease, obesity, chronic use of nonsteroidal anti-inflammatory drugs, history of acute kidney injury, bilateral kidney stones, or family history of CKD). Renal function was assessed using a rapid creatinine test (NovaMaxPro®-eGFR CKD-EPI 2021). Reduced eGFR was defined as < 60 mL/min/1.73 m2.</p><p><strong>Results: </strong>We analyzed 8,374 participants (66.9% women; median age, 58 years; BMI, 28.3 kg/m2; 46.2% mixed race). The frequency of reduced eGFR was 40.2% (n = 3,370), of whom 36% were in stages G3b-G5. Only 35.2% were aware of CKD risk factors. Significant regional differences were observed (ranging from 27.9% [Bahia] to 55.2% [Paraná]; p < 0.001). Independent predictors included age (OR = 1.032; 95%CI: 1.028-1.035), HTN (OR = 1.27; 95%CI: 1.15-1.40), and indigenous ethnicity as a protective factor (OR = 0.40; 95%CI: 0.20-0.89; p < 0.05). Risk increased by 23% for each additional risk factor.</p><p><strong>Conclusion: </strong>A high frequency of reduced eGFR and low awareness of CKD risk factors were observed. The study demonstrates the feasibility of POCTcr in screening strategies and reinforces the need for public policies to expand early diagnosis and strengthen primary care.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 3","pages":"e20250298"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous transhepatic venous access for hemodialysis: a single-center experience with a rescue access.","authors":"Mariana Sousa Freitas, Amanda Meyer Luz, Ademar Regueira Filho","doi":"10.1590/2175-8239-JBN-2024-0225en","DOIUrl":"10.1590/2175-8239-JBN-2024-0225en","url":null,"abstract":"<p><strong>Introduction: </strong>Central venous catheters (CVC) are often the only option for hemodialysis, particularly when arteriovenous fistulas cannot be created or in urgent situations. However, the exhaustion of traditional access sites necessitates alternative approaches. This study aims to describe our center's experience with transhepatic venous access for hemodialysis, focusing on infection rates, catheter patency, and dialysis adequacy, to evaluate the feasibility of this option in patients with limited vascular access options.</p><p><strong>Methods: </strong>We conducted a retrospective study at Pro-Rim Foundation (January 2017 - February 2024) on patients with transhepatic CVC. Clinical records were reviewed for demographics, comorbidities, CVC details, dialysis adequacy, and outcomes.</p><p><strong>Results: </strong>A total of 24 longterm transhepatic CVCs were placed in 12 patients (58.3% male, mean age 55.9 years). The technical success rate was 100%, with no complications within 24 hours. Over 3615 catheter-days, thrombosis occurred at a rate of 0.30 per 100 catheterdays, and infection occurred at 0.08 per 100 catheter-days. The mean dialysis dose (eKt/V) was 1.29. Seven patients died during follow-up, with only one death related to vascular access complications. The mean primary and secondary catheter patency times were 162.9 and 204.0 days, respectively.</p><p><strong>Conclusion: </strong>Our study supports transhepatic hemodialysis catheters as a viable option for patients with no other access options, showing good long-term functionality, low infection rates, and reasonable dialysis adequacy. Thrombosis remains a significant challenge, necessitating better maintenance, monitoring, and further research to improve outcomes.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e20240225"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105487","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 new face of dialysis: aging, diabetes, and challenges for vascular access.","authors":"Rosilene M Elias, Benedito Jorge Pereira, Maria Eugenia F Canziani","doi":"10.1590/2175-8239-JBN-2026-E004en","DOIUrl":"10.1590/2175-8239-JBN-2026-E004en","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":"e2026E004"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271069","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":"Pregnancy and maternal glomerular disease: a closer look.","authors":"MuhammadTaha Naeem, Saad Ahmed","doi":"10.1590/2175-8239-JBN-2025-0299en","DOIUrl":"10.1590/2175-8239-JBN-2025-0299en","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":"e20250299"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142485","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":"Peritoneal dialysis influences microRNA expression and pro-inflammatory response: results from a cross-sectional study.","authors":"Nara Aline Costa, Amanda Gomes Pereira, Hellen Christina Neves Rodrigues, Lilian Cuppari, Tainara Francini Felix, Iael Weissberg Minutentag, Patricia Pintor Reis, André Luis Balbi, Bertha Furlan Polegato, Paula Schmidt Azevedo, Leonardo Antonio Mamede Zornoff, Sérgio Alberto Rupp de Paiva, Daniela Ponce, Marcelo Macedo Rogero, Marcos Ferreira Minicucci","doi":"10.1590/2175-8239-JBN-2024-0218en","DOIUrl":"10.1590/2175-8239-JBN-2024-0218en","url":null,"abstract":"<p><strong>Introduction: </strong>The investigation of circulating microRNAs (miRNAs) and inflammatory response associated with the different stages of chronic kidney disease (CKD) may reveal biomarkers of disease pathogenesis. Our goal was to identifying differences in the circulating miRNAs expression between peritoneal dialysis (PD) and non-dialytic (ND) patients and determine the regulatory miRNA-target gene networks and pathways potentially involved in disease pathogenesis.</p><p><strong>Methods: </strong>This was an exploratory cross-sectional study that included ND and PD patients with CKD stage 5 over 18 years of age. Inflammatory biomarkers and circulating miRNA expression profiles were evaluated.</p><p><strong>Results: </strong>The study included 20 patients (57.2 ± 11.8 years). Levels of high-sensitivity C-reactive protein [0.37 (0.07-1.40) vs. 3.90 (2.50-5.79), p = 0.038] and interleukin-6 [3.35 ± 3.08 vs. 6.82 ± 4.08, p = 0.046] were significantly lower in the ND group in comparison to the PD group, respectively. Nine miRNAs were significantly deregulated (fold change (FC) ≥ 2 and p ≤ 0.05) in the PD compared to the ND group. Computational analyses showed a large number of target genes commonly regulated by at least two of the identified miRNAs. Pathway enrichment analysis showed that G protein-coupled receptor (GPCR) signaling, insulin secretion/resistance, and energy metabolism were among significant pathways regulated by miRNA target genes.</p><p><strong>Conclusions: </strong>Patients on PD treatment showed deregulated circulating levels of the 9 identified miRNAs and higher serum inflammatory biomarkers, compared to ND patients. Genes regulated by miRNAs are mainly associated with GPCR signaling, insulin resistance, and energy metabolism, playing roles in fibrosis and inflammatory-associated functions.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e20240218"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793844","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":"Acute kidney injury in patients undergoing cardiac transplantation: a cohort study on incidence and risk factors in the first three years of service implementation.","authors":"Mariana Moura Ferreira, Marcello Laneza Felicio, Flávio de Souza Brito, Leonardo Rufino Garcia, Daniela Ponce","doi":"10.1590/2175-8239-JBN-2025-0135en","DOIUrl":"10.1590/2175-8239-JBN-2025-0135en","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) is a common complication in the postoperative period of heart transplantation and is associated with unfavorable patient outcomes.</p><p><strong>Objective: </strong>To analyze the incidence of AKI in patients undergoing heart transplantation and to identify preoperative, intraoperative, and postoperative risk factors associated with its development.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study including patients who underwent heart transplantation during the first three years of the program at a tertiary hospital in the State of São Paulo, from January 2020 to January 2023. Patients with chronic kidney disease (CKD) stages 4 or 5 and prior kidney transplantation were excluded.</p><p><strong>Results: </strong>The incidence of AKI was 48%. Logistic regression analysis demonstrated an association between AKI and the following factors: pre-existing CKD (OR = 3.155; 95% CI 1.343-6.340; p = 0.031), cold ischemia time (OR = 1.956; 95% CI 1.126-3.053; p = 0.042), and higher doses of norepinephrine in the first postoperative day (OR = 5.211; 95% CI 2.696-8.987; p = 0.028). There was no significant difference in mortality between patients who developed AKI and those who did not (58.3% vs. 38.5%; p = 0.09).</p><p><strong>Conclusion: </strong>The incidence of AKI was high (48%) in this population. The main risk factors for its development were pre-existing CKD, prolonged cold ischemia time, and higher doses of norepinephrine in the first postoperative day.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 1","pages":"e20250135"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377479","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}