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In Mexico, chronic kidney disease is a major public health problem in pediatric patients. The therapeutic options for chronic kidney disease (CKD) in children are dialysis and kidney transplant (KT); the latter constitutes the current treatment of choice for children suffering from end-stage renal disease. The aim of this study was to describe our experience of perioperative treatment of pediatric patients undergoing en bloc kidney transplant. Female patient, 12 years old, from Veracruz, Mexico, suffering from stage 4 CKD according to KDOQI criteria, secondary to glomerulonephritis. An en bloc kidney transplantarion from a pediatric deceased donor was performed; balanced general anesthesia with mechanical ventilation was used. Cold ischemia time was 17 hours and warm ischemia time was 30 minutes. The surgery lasted 5 hours and 10 minutes and the total anesthesia time was 6 hours. The patient was taken to the pediatric intensive care unit and showed an adequate renal graft acceptance. During the following seven months the clinical course was satisfactory and kidney echotomography showed normal results. Glomerulonephritis made this patient undergo hemodialysis replacement therapy due to CKD at a very early age. The en bloc kidney transplantation performed was successful thanks to the multidisciplinary management involved in the Kidney Transplant Program.

A case of right acute hydrotorax is reported in a 13 years old boy with terminal chronic renal failure in CPD (chronic peritoneal diálysis); it is a rare complication and in our experience in the chronic peritoneal dialysis program in Hospital del niño Jesus, Tucuman, in 12 years of duration is the first case. We inform the evolution, diagnosis and resolution.

Foundation: chronic renal failure has a negative impact in the quality of life and constitutes a morbidity predictor in patients with periodic hemodialysis.Objective: to evaluate the influence of quality of life related to health in the morbidity of patients in intermittent periodic hemodialysis.Methods: a descriptive study was done in patients with three or more time of intermittent periodic hemodialysis at the Nephrology service of the Military Hospital Dr. Carlos J. Finlay. Havana, in a 12 month follow up period. The variables analyzed were: age, sex, time with the substituting renal function treatment, morbidity rate, type of morbidity in hemodialysis and hospital admission rate. A questionnaire for quality of life in patients with renal disease (version 1.3) was applied.Results: patients under 60 years old predominated, of high schooling level, with blood hypertension mainly due to renal failure. The most frequent morbidities were: chills, arterial Hypotension, and complications related to vascular access. The admission rate was low. The summary physical component had the lower punctuation followed by the summary mental component. Among these and age there was found an inversely proportional correlation, so as the morbidity rate and the summary physical component.Conclusion: the results obtained are related to preceding studies. The physical component summary results with higher involvement, mainly in the older adult, considering the negative relation with the morbidity rate and hospital admission.

La literatura más reciente indica que la enfermedad renal crónica constituye la comorbilidad con mayor riesgo de desarrollar enfermedad grave por SARS-CoV-2, coronavirus 2019 (COVID-19). Muchas sociedades científicas se han posicionado a favor de la vacunación de los pacientes con enfermedad renal crónica como prioritaria, debido a esta alta vulnerabilidad. En España, la quinta actualización de la Estrategia de vacunación frente a COVID-19 del Consejo Interterritorial de Salud, incluyó a los pacientes con ERC dentro del grupo 7 (personas con condiciones de muy alto riesgo). A lo largo del artículo se describen los tipos de vacunas según mecanismo de acción, las vacunas actualmente aprobadas por la Agencia Europea del Medicamento (EMA) y todo lo relacionado con el proceso de vacunación (preparación, administración y seguimiento), además de los aspectos a tener en cuenta en los pacientes con enfermedad renal crónica.

To identify the occurrence of fatigue in the elderly with chronic kidney disease undergoing hemodialysis. A descriptive, cross-sectional study with a quantitative approach, carried out from September to November 2018 using the revised Piper Fatigue Scale. 45 elderly people aged 60 to 86 years participated on the study, 62.2% were male. Fatigue was identified in 97.7% of the elderly and the most frequently attributed causes were hemodialysis (37.8%) and stress (13.3%). As for the factors that promoted fatigue relief, rest (53.3%), sleep (6.7%) and eating (6.7%) were described. Fatigue proved to be a relevant finding among the elderly surveyed, which is why it deserves the attention of the nursing team for identification and adequate management. [ABSTRACT FROM AUTHOR]

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermagem Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Nursing UFPE / Revista de Enfermagem UFPE is the property of Revista de Enfermagem UFPE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermería Nefrológica is the property of Sociedad Espanola de Enfermeria Nefrologica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Este documento de recomendaciones tiene como objetivo orientar a médicos nefrólogos y no nefrólogos que asisten a pacientes con enfermedad renal crónica (ERC) en todas las etapas de la misma, en el proceso de vacunación contra el SARS-CoV-2. Como consecuencia de la situación epidemiológica y de los tiempos del proceso de elaboración de las vacunas disponibles, no se ha generado evidencia lo suficientemente potente, por lo que las recomendaciones no se acompañan del nivel de evidencia. Se fundamenta la necesidad de priorizar la vacunación en este grupo de pacientes en el mayor riesgo de adquirir la infección por SARS-CoV-2, desarrollar la enfermedad COVID-19 con mayor gravedad y presentar una mortalidad más elevada que la población general. Las recomendaciones se organizan por grupos de pacientes considerando pacientes con ERC no dialítica, diálisis y trasplante renal, y pacientes bajo tratamiento inmunosupresor.

Antecedentes: La enfermedad renal cursa con alteraciones de la hemostasia aumentando el riesgo de eventos trombóticos y hemorrágicos. Objetivo: Describir las anormalidades de la coagulación en pacientes con urgencia dialítica según tromboelastografía y pruebas convencionales. Materiales y métodos: Serie de casos de 60 pacientes adultos con urgencia dialítica. Se tomaron muestras de sangre previo al implante de catéter de hemodiálisis o de diálisis peritoneal, se procesaron para tromboelastografía y pruebas convencionales. Resultados: En la interpretación global del tromboelastograma se identificó estado hipercoagulable en 60% de los pacientes. En el análisis individual de parámetros del trazado se demostraron alteraciones en la fase enzimática con ángulo-alfa aumentado en el 61.7% y tiempo R acortado en el 58.3% de los casos, alteraciones en la fase celular con MA y G aumentados en cerca del 45% y alteraciones en la estabilidad con hiperfibrinolisis en el 18%. El aPTT estaba prolongado en 23.7%. Conclusiones: En la interpretación global de la tromboelastografía de pacientes con urgencia dialítica el hallazgo mas frecuente es el estado hipercoagulable. En el análisis individual se encontraron alteraciones en todas las fases de la coagulación, siendo la mas frecuente la formación acelerada del coágulo, seguida por aumento de la fuerza del mismo. La tromboelastografía debería ser considerada como una prueba enfocada en la cabecera del paciente para la valoración de la hemostasia en estos pacientes. Palabras clave: insuficiencia renal crónica; lesión renal aguda; uremia; diálisis renal; tromboelastografía; enfocada en la cabecera del paciente

Objective: To know the nurse's routine in the hemodialysis sector of a public hospital in Northeast Brazil. Methods: Field study of exploratory and descriptive nature, qualitative approach. Developed in the hemodialysis sector of a public hospital located in Campina Grande, Paraíba, with all nurses working in the sector. Data collection took place in September 2017, through semi-structured interviews, and analyzed following the theory proposed by Bardin. Results: Nurses were interviewed with an average age of 41 years, predominantly female and with an average time of eight years working in the hemodialysis sector. The following categories emerged from the content analysis: Nursing assignments in the hemodialysis sector; Nursing management in the hemodialysis service; Systematization of nursing care in the hemodialysis service; Adversities and complications found in the hemodialysis sector; and Actions by the nursing team to minimize risks and possible complications. Conclusão: The multiplicity of duties and activities in the routine of nurses in the hemodialysis sector was evident in our study, which showed the essential role and role of nurses within such a specific and highly complex sector. [ABSTRACT FROM AUTHOR]

Background: Infection by the hepatitis c virus has been recognized as a health problem worldwide. Objective: To determine the characteristics of patients with hepatitis C receiving treatment in the Hemodialysis Service of the Cienfuegos Specialized Outpatient Center from January 2019 to August 2019. Methodology: An observational, descriptive, longitudinal retrospective study was carried out with the 54 Hemodialysis patients with Hepatitis C. The variables used were: age, sex, place of origin, type of vascular access and time in treatment. The database of the Provincial Center for Hygiene, Epidemiology and Microbiology in Cienfuegos was used as a source of information. Results: The highest percentage of people with hepatitis C was concentrated between 50 to 54 years old; The average age being 53 years, the male sex stood out for the 84.93%, with the municipality of Cienfuegos predominating as the place of residence. Regarding the type of vascular access, the arterio-venous fistula contributed the 98.14%, while the treatment time that prevailed was more than 3 years for the 77.8%. Conclusions: Hepatitis C in the hemodialysis service showed a similar behavior as described in the literature. [ABSTRACT FROM AUTHOR]

The case report of an 18 years adolescent is described with pathological history of a surgery due to hypertelorism in his first year of life who was assisted in the Nephrology Service of Dr. Juan de la Cruz Martínez Maceira Northern Teaching Children Hospital in Santiago de Cuba, due to a marked decrease of the renal function, reason why he required substitute therapies. His condition persisted for more than 3 months and it was considered as a chronic kidney failure in end stage. Several complementary exams were carried out to find out the cause and other specialties participated in the diagnosis, as Clinical Genetics, due to the presence of dysmorphic disorders; finally, Robinow syndrome was diagnosed. The patient remained with hemodialysis for 2 years until her condition was stable to receive a renal transplant. [ABSTRACT FROM AUTHOR]

Objective: To compare the quality of life of patients undergoing hemodialysis, who lived in the city where they underwent treatment with those who lived in other municipalities in the state of Sergipe. Methods: This is a cross-sectional, descriptive and comparative study, carried out in a dialysis clinic in Sergipe. The sample consisted of 170 adult patients undergoing hemodialysis with cognitive conditions to respond to the form. The quality of life outcome was measured using the Brazilian version of Kidney Disease and Quality-Of-Life Short-Form (KDQOL-SF). Sociodemographic and service access data were considered dependent variables for comparison between groups. Results: Regardless of the origin and sociodemographic characteristics of the participants, low scores for quality of life were found in all components of the assessment, especially means below 50. On the other hand, it was noticed that patients from the countryside had higher quality scores of life. Conclusion: Male patients, with an average age of 40 years, with higher education and coming from the interior had better scores for quality of life. [ABSTRACT FROM AUTHOR]

Introduction: adults with chronic kidney disease (CKD) have a higher risk of developing ulcers, especially lower extremities. However, there are limited data on prevalence and associated factors. Objective: to determine the prevalence of ulcers in the lower limbs and their associated factors in patients with chronic kidney disease who attend a IV level of complexity institution. Method: observational, cross-sectional, and analytical study, the sample was 561 participants. The instruments were a sociodemographic and background datasheet and the Ankle-Brachial Index (ABI). Results: the participants were primarily men (67%), with an average age of 62 years; Statistical significance (p <0.05) was found between the variables history of diabetes, low ABI, having had a previous ulcer, and the presence of an ulcer in the lower limbs. Conclusions: studying this phenomenon in renal care units becomes necessary due to the high prevalence and associated risk factors; it allows the planning of strategies aimed at prevention. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira em Promoção da Saúde is the property of Revista Brasileira em Promocao da Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Pesquisa: Cuidado é Fundamental is the property of Revista de Pesquisa: Cuidado e Fundamental Online and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Facultad de Medicina de la Universidad Nacional de Colombia is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: La enfermedad renal crónica avanzada supone un gran problema sanitario para el que son primordiales los cuidados de enfermería y por tanto la formación de los futuros profesionales. Objetivo: evaluar la percepción de conocimientos y el grado de interés en enfermería nefrológica de los estudiantes de enfermería de la Universidad de Oviedo. Material y Método: Estudio observacional descriptivo desarrollado entre enero-mayo de 2019, se incluyeron todos los alumnos matriculados del grado de enfermería que dieron su consentimiento por escrito. Se utilizó un cuestionario realizado por los investigadores, que incluyo variables sociodemográficas y 12 preguntas cerradas, formadas por dos tipos de respuesta: dicotómicas (si/no/no sabe) y tipo Likert (escala de 0 a 10). Se realizó un análisis descriptivo y se utilizaron las pruebas T de Student y ANOVA para buscar diferencias significativas. Resultados: Obtuvimos 251 cuestionarios, con un índice de rechazo

Objetivo: describir la experiencia de los pacientes que transitan de hemodiálisis a diálisis peritoneal. Método: estudio cualitativo fenomenológico con nueve entrevistas semiestructuradas, entre septiembre de 2017 a mayo de 2018. Criterios de inclusión: autonomía para la diálisis peritoneal, cambio de terapia renal sustitutiva y permanencia mínima de dos meses en la antigua y nueva terapia renal. Criterios de exclusión: hemodiálisis domiciliaria y deterioro psíquico o cognitivo. Un paradigma de codificación deductivo-inductivo reveló cinco categorías principales. Resultados: la transición denotó separarse de una vida dependiente de terceros y experimentar cambios de vida, y ajustes para gestionar la terapia domiciliaria. Conclusión: la experiencia vivida movilizó recursos para adquirir una identidad integradora fluida, renaciendo un rol caracterizado por satisfacción personal y responsabilidad con el autocuidado.

Objetivo: describir las características demográficas y clínicas de los pacientes con enfermedad renal crónica (ERC) en estadio 3-5 y la asociación de variables con mortalidad. Materiales y métodos: estudio observacional, descriptivo y transversal, con enfoque analítico; Realizado en Florencia Caquetá, en una IPS privada en el servicio de nefrología, se analizaron las variables sociodemográficas, clínicas, a través de análisis univariado y bivariado, aplicando prueba de asociación con mortalidad mediante chi cuadrado y regresión logística simple para calcular razones de prevalencia (PR). Resultados: se evaluaron a 213 pacientes, con un promedio de edad de 60,0 ±1,4 años; y un 48,3% de mujeres, con una mortalidad registrada de 29,5%. Se hallaron como factores asociados a mortalidad: LDL < 70 mg/dL (PR 0,45; IC95%: 0,24-0,84), y Albumina < 3,5 mg/dL (PR 12,65; IC95%: 5,85-27,3). Conclusión: la hipoalbuminemia y los niveles bajos de LDL se presentan como factores asociados a la mortalidad en pacientes con ERC en estado 3-5 de Florencia-Caquetá. En el caso de la hipoalbuminemia, ésta se presenta como un factor de riesgo, mientras que los valores de LDL menores a 70 mg/dL, son un factor protector.

Objetivos: estimar el riesgo de tuberculosis (TB) en pacientes en terapia de reemplazo renal diálisis (TRR) y analizar la variación de la incidencia, su presentación clínica y pronóstico. Método: estudio retrospectivo desde 1995 a 2013. Los datos fueron extraídos del Registro Uruguayo de Diálisis y de la Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes (CHLA-EP). Se analizó la forma de diagnóstico, presentación clínica, prueba de tuberculina, evolución y mortalidad. Asimismo, se estudiaron variaciones de incidencia, riesgo y relación temporal con la terapia de reemplazo. Resultados: en 18 años, 10.516 pacientes recibieron diálisis crónica en Uruguay, y 13.083 casos de TB fueron diagnosticados. El 1,4% (n= 119) de todos los casos de TB en ese período fueron pacientes en TRR. La incidencia de TB en la población general en el período estudiado fue de 21 casos cada 100.000 pacientes/año (cp105) vs 212 cp105 en TRR. El riesgo de TB fue ocho veces mayor en TRR (SIR: 8, IC95% [6,5-9,3]). El tiempo medio de TRR al momento del diagnóstico fue de cuatro años (0 a 20), el 37,8% de los casos sucedieron en los dos primeros años de TRR; sin embargo, la incidencia se incrementó significativamente luego de los nueve años de TRR. La letalidad en la población general relacionada TB fue de 10,3%, siendo esta cifra duplicada en la población en TRR (23,5%). Conclusiones: el riesgo de TB en TRR es mayor y su mortalidad duplica la de la población general.

Introducción: La diabetes es una de las principales causas de enfermedad renal crónica en Chile y el mundo, por lo que es fundamental la prevención del avance de la nefropatía diabética para evitar la evolución de la enfermedad renal crónica. Objetivo: Determinar las características de pacientes diabéticos que iniciaron tratamiento renal sustitutivo con hemodiálisis debido a una nefropatía diabética. Material y Método: Se realizó un estudio cuantitativo de tipo descriptivo, con pacientes diabéticos y en hemodiálisis, mediante aplicación del test de Morisky Green y un instrumento de valoración sociodemográfico. Los sujetos fueron seleccionados mediante muestreo intencionado, tras su consentimiento informado. Resultados: Los sujetos estudiados en su mayoría fueron mujeres, con diabetes tipo 2 en edad adulta, de un estrato económico bajo, escolaridad básica y media, y pertenecientes al Sistema de Salud Público. Gran parte indicó que tenía 5 o más años con diabetes al momento de ingresar a diálisis. 71,4% de ellos no tuvo derivación a Nefrólogo y 57,1% refirió no haber sido adherente a su tratamiento, previo ingreso a diálisis. Conclusiones: El perfil del paciente diabético que inicia HD de nuestro estudio, son en su mayoría mujeres de edad media, con diagnóstico previo de DM2 sobre la DM1, y con más de 20 años con el diagnóstico de DM. En cuanto al perfil socioeconómico predominan los pacientes con bajos ingresos económicos y ninguna formación o estudios básicos. Por último destacar que presentaron mejor adherencia al tratamiento los hombres respecto a las mujeres.

Introduction: chronic kidney disease is considered a growing socio-economic and public health problem for all systems worldwide. Objective: characterize hemodialysis older adults at “Abel Santamaria Cuadrado” General Teaching Hospital during 2016-2017. Method: an observational, descriptive cross-sectional study was conducted, the target group was made up of the 139 patients suffering from chronic kidney disease who underwent hemodialysis treatment in the period study, the sample included 53 older adult patients, the data obtained was stored in a database for further analysis and processing, using descriptive statistics to present the results obtained. Results: male sex predominated (66 %), the age group from 65 to 69 (37,7 %). Hypertension was the cause of the utmost prevalence (41,5 %), the type vascular access for hemodialysis most applied in patients was the central venous catheter (60 %), and cardiovascular disease was the clinical characteristic associated with a morbidity and mortality rate of higher incidence (50,9 %). Cardiovascular diseases prevailed as the main causes of death (17 %). Conclusions: older adults with hemodialysis treatment suffered from diabetes mellitus and/or hypertension as the principal comorbidities, which constitute at the same time, the triggering causes of the disease. The use of central venous catheter was common as a venous access. Cardiovascular diseases constituted the principal causes of mortality.

Introduction: Malnutrition, being a condition with a multifactorial etiology, is very frequent in dialysis patients. Objective: To make a diagnosis of the situation and the evolution of parameters following nutrition intervention. Expected goals after six months: nutritional assessment of 100% of patients; 70% with type A subjective global assessment (SGA); 80% with ≥3.5 g/dL albumin levels, and 70% with >0.8 g/kg/day protein intake (nPNA). Methods: Patients undergoing dialysis for more than 90 days were evaluated during March and April (diagnostic stage) and November and December 2016 (evolution of parameters), recording personal, anthropometric and laboratory data, food history and SGA. The nutritional actions were: interviews to patients and relatives, education through group talks and indication of hyperproteic supplements to patients selected according to appetite, weight loss and albumin. Results: In the diagnostic stage, 35 patients were evaluated; 18 (51%) had BMI > 23 and < 35; 9 (26%) with nPNA > 0.8 g/kg/day. Albumin was ≥3.5 g/dL in 24 patients (69%). Type A SGA in 16 patients(46%); type B in 12 of them (34%) and type C in 7 (20%). Five patients received supplements (14%). In a later stage, 28 patients were evaluated; 11 (39%) with BMI > 23 and < 35. nPNA; > 0.8 g/kg/day in 27 patients (96%). Albumin was ≥3.5 g/dL in 23 patients (82%). Type A SGA in 18 patients (64%); type B in 9 of them (32%) and type C in 1 (4%). 100% of the supplemented subjects achieved the expected goals. Conclusion: Periodic nutritional assessment, interventions and supplementation improve the short-term nutritional goals of the dialysis population.

Introducción: la fístula arteriovenosa autóloga es el acceso vascular óptimo para los pacientes que se realizan hemodiálisis, desde su confección, maduración y utilización esta puede presentar varias complicaciones, siendo los pseudoaneurisma sobre las fístulas arteriovenosas autólogas una de las complicaciones infrecuentes. Presentación del caso: se presenta el caso de un paciente de 40 años, masculino con antecedente de hipertensión arterial, aneurisma cerebral, insuficiencia renal crónica en hemodiálisis utilizando como vía de acceso fístula arteriovenosa autóloga que desarrolló un pseudoaneurisma trombosado. Se exponen aspectos clínicos y quirúrgicos relacionados con este. Conclusiones: se reportó el caso de un paciente con pseudoaneurisma trombosado desarrollado sobre fístula arteriovenosa autóloga, una complicación infrecuente pero que su resolución quirúrgica permitió prolongar la vida útil del acceso vascular.

Introducción: La intoxicación por metanol constituye una entidad clínica que puede cursar con mal pronóstico neurológico, cardiaco, renal, metabólico e incluso letalidad. Actualmente, la frecuencia de aparición es baja o subestimada, obedeciendo sobre todo a intentos autolíticos o intoxicaciones accidentales. El diagnóstico precoz y la instauración temprana del tratamiento adecuado es vital para evitar la morbimortalidad. Descripción del caso: Presentamos el caso de una intoxicación aguda por metanol manifestada por acidosis metabólica severa, compromiso del estado de conciencia y secuelas neurológicas; luego de la instauración del tratamiento, con resultados favorables gracias al inicio temprano con terapia de reemplazo renal. Conclusiones: La importancia de este caso es resaltar la necesidad temprana de terapia de reemplazo renal ante la sospecha de acidosis metabolica en el contexto de alcoholes.

Reports of pregnant patients with chronic kidney disease on hemodialysis (CKDHD) with successful births are becoming more frequent. In the Ministry of Health there are no publications of official records of patients on dialysis and, therefore, data about pregnant women on dialysis are unknown. A retrospective and multicenter study was conducted on patients with CKDHD who had successful births in the public hospitals of Lima. Only 4 were found to have enough data for the report. The patients had an average age of 29 years (SD: 4.8), with an average gestation time at the end of pregnancy of 30.5 weeks (SD: 3.69). Preeclampsia was the most common complication in 2 out of 4 patients and all patients had less than 20 hours of treatment per week. The Ministry of Health should propose contingency measures for the management of these cases, which will be more and more frequent.

Introduction: There is a great incidence of fractures in patients suffering from end-stage chronic disease. This is partly caused by chronic kidney disease-mineral bone disorder and partly by the high prevalence of muscle weakness in these patients. Objective: Our objective was to identify the determining factors of muscle strength measured by means of handgrip strength (HGS) in chronic hemodialysis patients. Methods: A cross-sectional study was conducted on adult patients in a hemodialysis center. Handgrip strength (HGS) and lean mass index (LMI) were measured, as well as albumin and magnesium values and other serological parameters. Multiple linear regression was used to assess HGS predictors. Results: We analyzed 139 patients (88 men and 51 women; age: 60.7 ± 16); 18 subjects were excluded. Mean albumin values: 3.8 +/- 0.47 mg/dL; median hemodialysis time: 37 months (15-83). From the total number of patients, 25% (n=35) were found to be sarcopenic and 21.5% (n=30) had a history of diabetes. The univariate analysis showed a positive correlation between magnesium and HGS (ß 0.19 p 0.02). According to the multivariate analysis, all the following showed a correlation with HGS and were statistically significant: (R2 0.61 p

Perforating dermatoses (PD) represent a heterogeneous group of inherited or acquired diseases characterized by transepidermal migration of dermis extracellular matrix components (collagen, elastic tissue or necrotic connective tissue) following an inflammatory and/or degenerative process. The etiopathogenesis of acquired perforating dermatosis (APD) is unknown. However, it is strongly associated with minor trauma, chronic renal failure and diabetes mellitus and, less frequently, with endocrinological diseases, infectious diseases, neoplastic growth, among others. Acquired perforating dermatoses are diagnosed in 10-12 % of patients undergoing hemodialysis. Itching constitutes the main symptom of this disorder. In some cases, it may be incapacitating and secondary excoriation due to scratching may cause extensive lesions altering the skin barrier function. We report the cases of two patients undergoing hemodialysis three times a week, both with a history of diabetes mellitus and end-stage chronic renal failure requiring renal replacement therapy (RRT). These patients presented with generalized itching dermatosis which had been going on for months. Upon physical examination, raised, hyperpigmented lesions with an umbilicated center and surrounded by an erythematous halo were observed on the face, trunk and limbs. Histopathological examination revealed APD.

Introduction: Bone and mineral metabolism disorder is a serious complication of Chronic Kidney Disease. Concerning phosphorus, the new KDIGO Guidelines suggest a reduction of hyperphosphatemia, but they do not recommend a specific value. However, in Argentina, a phosphorus value of 5 mg/dL or less is used as a dialysis quality indicator (DiaQualInd). Our objective was to evaluate whether this goal is currently valid as a DiaQualInd. Methods: A multicentric, crosssectional study was conducted. Patients older than 18 were included, with more than 90 days undergoing hemodialysis. Demographic and laboratory data were tabulated, comparing normophosphatemic with hyperphosphatemic values. According to this method, in 3 centers the upper reference limit was 4.5 mg/dL and in 4 centers it was 5.6 mg/dL. The latter were analyzed as a separate group (F 5.6). Results: There were 333 patients included in this study. Age, sex, AVF percentage, diabetes, time on dialysis, Kt/V, hemoglobin and albumin were similar to the registry data. The median phosphatemia was 5.2 mg/dL, (range: 2.3 to 10.6). The hyperphosphatemic patients were the youngest, spent less time on dialysis and showed higher hemoglobin and albumin values. In group F 5.6 (n = 203), according to KDIGO only 33.7% would need treatment. If this DiaQualInd were to be applied (phosphorus lower than 5 mg/dL), the percentage would be 55%, that is, 21.3% of normophosphatemic patients should be treated. Conclusions: Phosphatemia determination should be standardized before using a fixed value such as DiaQualInd.

Objective: Our objective was to establish the frequency of early referral to the nephrologist for the initiation of hemodialysis (HD) and its associated epidemiological factors in patients with chronic kidney disease (CKD) in a public hospital in Peru. Material and methods: We conducted an analytical cross-sectional study in patients who started HD in a public hospital in Peru. Our main variable was early referral, defined as patients who received an indication of onset of HD after 180 days of the first appointment in the nephrology service. We collected epidemiological and laboratory variables. We used crude and adjusted generalized linear models (GLM) and we calculated the proportion ratio (PR) with a 95% confidence interval (CI) as a measure of association. Results: We evaluated 148 patients; we found early referral in 17% of the population. In the adjusted GLM, participants older than 60 years had a higher proportion of early referral to the nephrologist, PR = 2.17; 95% CI (1.09-4.32); p = 0.03. We showed a lower frequency of early referral among participants with severe anemia, PR = 0.15; 95% CI (0.02-1.11); p = 0.06. Conclusions: The frequency of early referral is low and it should be considered a public health problem. We recommend improving the process of referral in our health care network. How to cite this article: Huauya-Leuyacc C, Palacios-Guillen AM, Benites-Zapata VA. [Epidemiological factors associated with early referral to a nephrologist to start chronic hemodialysis in patients at a Public Hospital in Peru]. Rev Nefrol Dial Traspl. 2018; 38(2):126-33.

Introduction: Cardiovascular diseases (CVD) are one of the most common causes of mortality in chronic kidney disease. Smoking is a well defined risk factor for atherosclerotic cardiovascular disease. Interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), high sensitive C-reactive protein (hsCRP) and endothelin-1 (ET-1) have found elevated in chronic inflammatory process. We aimed to evaluate if IL-6, TNF-alpha, hsCRP and ET-1 are increased in smoker hemodialysis (HD) patient compared to non-smoker HD individuals to potentially refer us cardiovascular diseases noninvasively. Material and methods: 80 smoker and 50 non-smoker maintenance hemodialysis male patients with similar demographic characters, dialysis and support treatment and metabolic profile. In addition to routine tests, we took samples for evaluating IL-6, TNF-alpha, hsCRP and endothelin-1. P values were measured. Results: In smoker HD patients, IL-6, TNF-alpha, hsCRP and endothelin-1 levels were found increased level statistically significant compared to non-smoker indiviuals. Conclusion: This study may refer us that smoking is an additional risk factor among HD individuals by increased levels of IL-6, TNF-alpha, hsCRP and ET-1. How to cite this article: Hulya Ç, Şule C, Bahar E, Saliha A, Sibel E, Papatya D. Evaluation of Smoking as an additional risk factor for cardiovascular diseases among hemodialysis patients by increased levels of Il-6, TNF-Alpha, hs-CRP and Endothelin-1. Rev Nefrol Dial Traspl. 2018; 38(2):103-10.

Type 2 diabetes (DM2) is one of the greatest public health problems in the world and one of the biggest challenges of the 21st century. Glycemia is a laboratory parameter that is easy to evaluate and plays a fundamental role both in the diagnosis of DM and in its follow-up. The identification of glycated proteins, especially hemoglobin (HbA1c) and serum proteins (fructosamine), makes it possible to quantify their average over weeks or months, which complements glucose monitoring. The methods implemented to achieve glycemic control in chronic kidney disease (CKD) are extrapolated from studies on DM without CKD, due to the lack of evidence from high quality randomized studies in this population. It should be considered that in CKD there are metabolic changes determining that hemoglobin (Hb) shows variable behaviors; this is why it is discussed whether HbA1c constitutes a reliable marker to define glycemic control or whether it is useful to predict the development of complications in this subpopulation. A review of the role of HbA1c in DM patients without CKD is presented, showing also the difficulties that arise in the subpopulation with CKD, especially among patients undergoing hemodialysis and peritoneal dialysis.

Introduction: Chronic kidney disease is a condition that affects both patients and their families in every aspect of life. One of them which has not been much explored and which bears a direct relation with life quality is sexuality in patients undergoing dialysis. Methods: A qualitative study within the post-positivist paradigm and from the perspective of a grounded theory was conducted. The in-depth interview was used as a data collection technique. Seven women on dialysis participated. Objective: The main aim of this research was to explore sexuality in female patients undergoing dialysis. Results: After examining the interviews, the following categories were identified: corporality, sexual practice limitations, sexual practice adaptations, risk of infections, self-esteem, kind of couple relationship and fear of the future. Conclusions: For women on dialysis, sexuality is a fundamental aspect of their lives, which should be considered in the training of healthcare staff working in the renal area. Further research is suggested regarding women on peritoneal dialysis and with a greater number of participants.

Introducción: la infección por el virus de hepatitis C es frecuente en pacientes con insuficiencia renal crónica con o sin tratamiento hemodialítico; en ellos este agente patógeno es la principal causa de enfermedad hepática. Objetivos: describir aspectos epidemiológicos, clínicos, endoscópicos e histológicos del hígado en un grupo de pacientes con insuficiencia renal crónica en régimen de hemodiálisis que padecen el virus de hepatitis C. Método: se realizó un estudio descriptivo y transversal entre abril de 2015 y marzo de 2016. El universo estuvo formado por todos los pacientes de 18 años y más, de ambos sexos, con insuficiencia renal crónica en régimen de hemodiálisis que padecen virus de hepatitis C, tratados en el Hospital “Arnaldo Milián Castro”; la muestra fue de 34 pacientes. Resultados: el mayor número de afectados correspondió al rango de 40 a 59 años de edad (61,8%) y predominó el sexo masculino (61,8%). Un total de 23 pacientes (67,6%) tenían más de seis años de evolución de la infección y la alaninoaminotransferasa estuvo elevada en 26 (76,5%). Fue la hepatomegalia el hallazgo clínico que predominó (20, 58,8%) y por examen laparoscópico (67,6%) e histológico (83,3%) destacó la hepatitis crónica. Conclusiones: la infección por el virus de hepatitis C fue más frecuente en el grupo de edades entre 40 y 59 años y predominó en hombres. El parámetro bioquímico de mayor relevancia fue la elevación de alaninoaminotransferasa y en la clínica predominó la hepatomegalia. A mayor tiempo de infección correspondió mayor afectación hepática, tanto endoscópica como histológicamente.

Background: Chronic kidney disease cost is considered high for health systems due to the amount of supplies required for treatment and increasing prevalence. Objective: Determine institutional cost of hemodialysis in chronic kidney disease. Method: Cost design from the institutional perspective, in patients with chronic kidney disease managed with hemodialysis. The sample size was 269 and the sample technique for consecutive cases. Annual fixed average cost (times and movements technique) and annual variable average cost (microcosting technique) adjusted by use of services, helped to identify annual average cost by function of production and service, the sum of these resulted in annual cost of care. Statistical analysis included averages and projections. Results: The average annual cost of the patient with chronic kidney disease on hemodialysis varies between $223,183 and $257,000; the cost in life is $1,198,968. The institutional total cost it corresponds to between 1.47% and 1.73% of the budget. Conclusions: Hemodialysis cost in chronic kidney disease is high for the institution, however, hemodialysis allows the survival of the patient. [ABSTRACT FROM AUTHOR]

Objective: To evaluate self care activities with arteriovenous fistula in chronic renal patients. Methodology: A descriptive, cross-sectional study with a quantitative approach, conducted with 60 patients in a dialysis unit in Northeast Brazil, from September to October 2018. Data were collected through interviews and analyzed using descriptive statistics. The study was approved by the Ethics and Research Committee (Opinion nº 233.953/13). Results: The most frequent cares were: not allowing blood pressure verification (71.7%) and medication administration and blood collection in the fistula limb (71.6%), perform fistula limb hygiene with water and antiseptic soap (68.4%) and avoid carrying weight (68.3%). The least reported cares were: putting warm compress on the day before hemodialysis (30.0%) and do pressure exercise with rubber ball (15%). Conclusion: The knowledge of chronic renal patients regarding self care activities with arteriovenous fistula was insufficient, and the most and least known care among patients was identified. These data reinforce the importance of educational activities planned by health professionals aimed at this audience and can assist nurses in planning these actions. [ABSTRACT FROM AUTHOR]

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Copyright of Enfermagem Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To unveil the senses and meanings of conservative treatment in people with chronic kidney disease (CKD). Materials and Methods: A descriptive and exploratory study with a qualitative approach. It was developed in 2017, with a sample of individuals with CKD undergoing conservative treatment. A semi-structured interview was used and the data were analyzed using simple descriptive statistics and content analysis. Results: 25 individuals participated in the study, of which 56% were female; 52% belonged to the 60-79-year-old age group; 48% were white-skinned; 48% did not complete elementary school; and only 12% worked. Content analysis revealed two categories: food restriction: anguishes and impacts that affect the daily lives of patients with CKD and the social imaginary and fear related to renal replacement therapy. Conclusions: The results revealed that diet and fear about dialysis therapy produce uncertainty, anxiety and insecurity, in addition to a wide and impacting change in people's lives. [ABSTRACT FROM AUTHOR]

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