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

{"title":"Parathyroidectomy: still the best choice for the management of severe secondary hyperparathyroidism.","authors":"Luiz Guilherme Fernandes Ramos, Daniela Del Pilar Via Reque Cortes, Luciene Machado Dos Reis, Fabio Luiz de Menezes Montenegro, Sérgio Samir Arap, Marília D'Elboux Guimarães Brescia, Melani Ribeiro Custódio, Vanda Jorgetti, Rosilene Motta Elias, Rosa Maria Affonso Moysés","doi":"10.1590/2175-8239-JBN-2023-0024en","DOIUrl":"10.1590/2175-8239-JBN-2023-0024en","url":null,"abstract":"<p><strong>Introduction: </strong>Management of secondary hyperparathyroidism (SHPT) is a challenging endeavor with several factors contruibuting to treatment failure. Calcimimetic therapy has revolutionized the management of SHPT, leading to changes in indications and appropriate timing of parathyroidectomy (PTX) around the world.</p><p><strong>Methods: </strong>We compared response rates to clinical vs. surgical approaches to SHPT in patients on maintenance dialysis (CKD 5D) and in kidney transplant patients (Ktx). A retrospective analysis of the one-year follow-up findings was carried out. CKD 5D patients were divided into 3 groups according to treatment strategy: parathyroidectomy, clinical management without cinacalcet (named standard - STD) and with cinacalcet (STD + CIN). Ktx patients were divided into 3 groups: PTX, CIN (cinacalcet use), and observation (OBS).</p><p><strong>Results: </strong>In CKD 5D we found a significant parathormone (PTH) decrease in all groups. Despite all groups had a higher PTH at baseline, we identified a more pronounced reduction in the PTX group. Regarding severe SHPT, the difference among groups was evidently wider: 31%, 14% and 80% of STD, STD + CIN, and PTX groups reached adequate PTH levels, respectively (p<0.0001). Concerning the Ktx population, although the difference was not so impressive, a higher rate of success in the PTX group was also observed.</p><p><strong>Conclusion: </strong>PTX still seems to be the best treatment choice for SHPT, especially in patients with prolonged diseases in unresourceful scenarios.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":"e20230024"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138470304","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":"Incidence of contrast-associated acute kidney injury: a prospective cohort.","authors":"André Lucas Ribeiro, Fabricio Bergelt de Sousa, Beatriz Cavalcanti Juchem, André Zimerman, Guilherme Bernardi, Manoela Astolfi Vivan, Tiago Severo Garcia","doi":"10.1590/2175-8239-JBN-2023-0019en","DOIUrl":"10.1590/2175-8239-JBN-2023-0019en","url":null,"abstract":"<p><strong>Introduction: </strong>Contrast-associated acute kidney injury (CA-AKI) is a deterioration of kidney function that occurs after the administration of a iodinated contrast medium (ICM). Most studies that defined this phenomenon used older ICMs that were more prone of causing CA-AKI. In the past decade, several articles questioned the true incidence of CA-AKI. However, there is still a paucity of a data about the safety of newer ICM.</p><p><strong>Objective: </strong>To assess the incidence of CA-AKI in hospitalized patients that were exposed to computed tomography (CT) with and without ICM.</p><p><strong>Methods: </strong>Prospective cohort study with 1003 patients who underwent CT in a tertiary hospital from December 2020 through March 2021. All inpatients aged > 18 years who had a CT scan during this period were screened for the study. CA-AKI was defined as a relative increase of serum creatinine of ≥ 50% from baseline or an absolute increase of ≥ 0.3 mg/dL within 18 to 48 hours after the CT. Chi-squared test, Kruskal-Wallis test, and linear regression model with restricted cubic splines were used for statistical analyses.</p><p><strong>Results: </strong>The incidence of CA-AKI was 10.1% in the ICM-exposed group and 12.4% in the control group when using the absolute increase criterion. The creatinine variation from baseline was not significantly different between groups. After adjusting for baseline factors, contrast use did not correlate with worse renal function.</p><p><strong>Conclusion: </strong>The rate of CA-AKI is very low, if present at all, with newer ICMs, and excessive caution regarding contrast use is probably unwarranted.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":"e20230019"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41176154","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":"High volume online hemodiafiltration: a global perspective and the Brazilian experience.","authors":"Maria Eugenia Fernandes Canziani, Jorge Paulo Strogoff-de-Matos, Murilo Guedes, Ana Beatriz Lesqueves Barra, Sinaia Canhada, Luciana Carvalho, Douglas Gemente, Carlos Eduardo Poli-de-Figueiredo, Roberto Pecoits-Filho","doi":"10.1590/2175-8239-JBN-2023-0104en","DOIUrl":"10.1590/2175-8239-JBN-2023-0104en","url":null,"abstract":"<p><p>Online hemodiafiltration (HDF) is a rapidly growing dialysis modality worldwide. In Brazil, the number of patients with private health insurance undergoing HDF has exceeded the number of patients on peritoneal dialysis. The achievement of a high convection volume was associated with better clinical imprand patient - reported outcomes confirming the benefits of HDF. The HDFit trial provided relevant practical information on the implementation of online HDF in dialysis centers in Brazil. This article aims to disseminate technical information to improve the quality and safety of this new dialysis modality.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":"e20230104"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885052","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":"Hemodiafiltration: a synergy yet to be convincing.","authors":"Brammah Rajarajeswaran Thangarajah","doi":"10.1590/2175-8239-JBN-2024-PO02en","DOIUrl":"10.1590/2175-8239-JBN-2024-PO02en","url":null,"abstract":"<p><p>The desperate attempt to improve mortality, morbidity, quality of life and patient-reported outcomes in patients on hemodialysis has led to multiple attempts to improve the different modes, frequencies, and durations of dialysis sessions in the last few decades. Nothing has been more appealing than the combination of diffusion and convection in the form of hemodiafiltration. Despite the concrete evidence of better clearance of middle weight molecules and better hemodynamic stability, tangible evidence to support the universal adoption is still at a distance. Survival benefits seen in selected groups who are likely to tolerate hemodiafiltration with better vascular access and with lower comorbid burden, need to be extended to real life dialysis patients who are older than the population studied and have significantly higher comorbid burden. Technical demands of initiation hemodiafiltration, the associated costs, and the incremental benefits targeted, along with patient-reported outcomes, need to be explored further before recommending hemodiafiltration as the mode of choice.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 2","pages":"e2024PO02"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287471","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":"Understanding of the role of serum creatinine in a subset of the Brazilian population.","authors":"Bruno Pellozo Cerqueira, Júlia Ferreira Rocha, Rafaela Francisquetti Barnes, Pedro Henrique Moretti Pepato, Thays Sellan Paim, Francisco De Nardi, Fabrício Akira Hsu, Juliana Miki Oguma, Leticia Miyuki Ito, Enio Yasuhiro Arimatsu Policarpo da Silva, Alexandre Vizzuso-Oliveira, Fernando Diniz Dos Santos Filho, João Vitor Bozza Maia, Juan Diego Zambrano Mendez, Beatrice Borges Sato, Roberto Matias Souza, Andre Kiyoshi Miyahara, Gianna Mastroianni Kirsztajn","doi":"10.1590/2175-8239-JBN-2023-0117en","DOIUrl":"10.1590/2175-8239-JBN-2023-0117en","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease is usually asymptomatic, and its diagnosis depends on laboratory tests, with emphasis on serum creatinine and proteinuria.</p><p><strong>Objective: </strong>To assess knowledge on the role of serum creatinine as a biomarker of kidney function in a sample of the Brazilian population.</p><p><strong>Method: </strong>Cross-sectional observational study conducted in São Paulo (SP, Brazil), in which a random adult population was interviewed.</p><p><strong>Results: </strong>A total of 1138 subjects were interviewed, with a median age of 36 years old (27-52); 55.1% were female. Regarding the \"creatinine\" biomarker, 40.6% stated they had never performed such a test. When asked about their knowledge on the usefulness of this exam, only 19.6% knew its function. The other responses were \"I don't know\" (71.6%), evaluating heart function (0.9%) and liver function (7.8%). Of those who reported they had already taken a creatinine test, only 29.4% correctly identified the role of creatinine. When dividing the groups into \"knows\" and \"does not know\" the function of creatinine, a statistically significant difference (p < 0.05) was observed regarding level of education, female sex, being a healthcare student/worker, having ever measured creatinine, knowing someone with kidney disease and older age. In the multivariate analysis, the main variable related to knowing the creatinine role was having previously taken the test (OR 5.16; 95% CI 3.16-8.43, p < 0.001).</p><p><strong>Conclusion: </strong>There is a significant lack of knowledge about creatinine and its use in checkups. The results indicate that greater efforts are needed from healthcare professionals to raise awareness on the role of serum creatinine.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":"e20230117"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139520944","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":"Severe secondary hyperparathyroidism: an increasing problem in CKD but the best management option is still unknown.","authors":"Mark Kung Dah Tiong, Nigel David Toussaint","doi":"10.1590/2175-8239-JBN-2024-E004en","DOIUrl":"10.1590/2175-8239-JBN-2024-E004en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 2","pages":"e2024E004"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158162","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":"Sodium-glucose cotranspor ter 2 (SGLT2) inhibitors in nephrolithiasis: should we \"gliflozin\" patients with kidney stone disease?","authors":"Mauricio de Carvalho, Ita Pfeferman Heilberg","doi":"10.1590/2175-8239-JBN-2023-0146en","DOIUrl":"10.1590/2175-8239-JBN-2023-0146en","url":null,"abstract":"<p><p>The prevalence of nephrolithiasis is increasing worldwide. Despite advances in understanding the pathogenesis of lithiasis, few studies have demonstrated that specific clinical interventions reduce the recurrence of nephrolithiasis. The aim of this review is to analyze the current data and potential effects of iSGLT2 in lithogenesis and try to answer the question: Should we also \"gliflozin\" our patients with kidney stone disease?</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139741004","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":"Dietitians' practices in dialysis units in Brazil: nutritional assessment and intervention.","authors":"Fabiana Baggio Nerbass, Aline de Araujo Antunes, Lilian Cuppari","doi":"10.1590/2175-8239-JBN-2023-0092en","DOIUrl":"10.1590/2175-8239-JBN-2023-0092en","url":null,"abstract":"<p><strong>Introduction: </strong>The importance of dietitians in dialysis units is indisputable and mandatory in Brazil, but little is known about the practices adopted by these professionals.</p><p><strong>Objective: </strong>To know practices adopted in routine nutritional care, focusing on nutritional assessment tools and treatment strategies for people at risk or diagnosed with malnutrition.</p><p><strong>Methodology: </strong>Electronic questionnaire disseminated on social media and messaging applications. It included questions that covered dietitians' demographic and occupational profile characteristics and of the dialysis unit, use and frequency of nutritional assessment tools, nutritional intervention strategies in cases of risk or diagnosis of malnutrition, prescription and access to oral supplements.</p><p><strong>Results: </strong>Twenty four percent of the Brazilian dialysis units (n = 207) responded electronically. The most used nutritional assessment tools with or without a pre-established frequency were dietary surveys (96%) and Subjective Global Assessment (83%). The strategies in cases of risk or presence of malnutrition used most frequently (almost always/always) were instructions to increase energy and protein intake from foods (97%), and increasing the frequency of visits (88%). The frequency of prescribing commercial supplements with standard and specialized formulas was quite similar. The availability of dietary supplements by the public healthcare system to patients varied between regions.</p><p><strong>Conclusion: </strong>Most dietitians use various nutritional assessment tools and intervention strategies in cases of risk or malnutrition; however, the frequency of use of such tools and strategies varied substantially.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139741063","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":"Risk factors for lower renal compensation after nephrectomy: an analysis of living kidney donors in an Amazonian cohort.","authors":"Luan Moraes Ferreira, Gisela Gomes Batista, Leoneide Érica Maduro Bouillet, Emanuel Pinheiro Esposito","doi":"10.1590/2175-8239-JBN-2023-0134en","DOIUrl":"10.1590/2175-8239-JBN-2023-0134en","url":null,"abstract":"<p><strong>Introduction: </strong>Living donor kidney transplantation is considered the ideal renal replacement therapy because it has a lower complication rate and allows an efficient response to the high demand for grafts in the healthcare system. Careful selection and adequate monitoring of donors is a key element in transplantation. Individuals at greater risk of developing kidney dysfunction after nephrectomy must be identified.</p><p><strong>Objective: </strong>To identify risk factors associated with a renal compensation rate (CR) below 70% 12 months after nephrectomy.</p><p><strong>Methods: </strong>This observational retrospective longitudinal study included living kidney donors followed up at the Lower Amazon Regional Hospital between 2016 and 2022. Data related to sociodemographic variables, comorbid conditions and kidney function parameters were collected.</p><p><strong>Results: </strong>The study enrolled 32 patients. Fourteen (43.75%) had a CR < 70% 12 months after kidney donation. Logistic regression found obesity (Odds Ratio [95%CI]: 10.6 [1.7-65.2]), albuminuria (Odds Ratio [95%CI]: 2.41 [1.2-4.84]) and proteinuria (Odds Ratio [95%CI]: 1.14 [1.03-1.25]) as risk factors. Glomerular filtration rate was a protective factor (Odds Ratio [95% CI]: 0.92 [0.85-0.99]).</p><p><strong>Conclusion: </strong>Obesity, albuminuria and proteinuria adversely affected short-term renal compensation rate. Further studies are needed to uncover the prognostic implications tied to these risk factors. Our findings also supported the need for careful individualized assessment of potential donors and closer monitoring of individuals at higher risk.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139741003","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":"Crystals unveiled: looking at urine can be quite useful.","authors":"Filipa Ferreira, Núria Paulo, Altin Ndrio","doi":"10.1590/2175-8239-JBN-2023-0160en","DOIUrl":"10.1590/2175-8239-JBN-2023-0160en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139520942","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}