Quality of life and depression in haemodialysis patients.

Chronic kidney disease is associated with a high prevalence of depression, which increases inversely with the glomerular filtration rate. This paper aims to evaluate the factors associated with a low quality of life and depression in patients on haemodialysis. Two hundred patients undergoing haemodialysis answered the Medical Outcomes Study 36 - Item Short - Form Health Survey (SF-36) and Beck Depression Inventory (BDI). Clinical and laboratory variables were analysed and correlated with these two tools. The prevalence of depression was 29%. Anaemia and hypoalbuminemia were independent risk factors for depression. All SF-36 domains showed worse results in patients with depression, and the pain domain presented the highest correlation. Our findings provide evidence that patients on haemodialysis have a low quality of life and a high prevalence of depression. A greater number of comorbidities, an excessive number of medications, diabetes mellitus, anaemia and hypoalbuminemia were associated with a reduced quality of life.

Acute kidney injury in leptospirosis: the Kidney Disease Improving Global Outcomes (KDIGO) criteria and mortality
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Acute kidney injury (AKI) is one of the most serious complications of leptospirosis. In recent years, studies have evaluated this complication using the risk, injury, failure, loss, and end-stage kidney disease and the acute kidney injury network classification systems. More recently, the kidney disease improving global outcomes (KDIGO) criteria have been developed to increase accuracy in detecting AKI. The aim of the present study was to determine the prevalence and factors associated with AKI and mortality in patients with leptospirosis, using KDIGO criteria. We conducted a retrospective analysis of patients with clinical and epidemiological diagnosis of leptospirosis between January 2007 and December 2011. AKI was defined and classified according to KDIGO guidelines. Independent risk factors for AKI and death were evaluated using logistic regression. Of the 205 patients included, only 10 patients (4.8%) exhibited Weil's syndrome. AKI occurred in 182 patients (88.7%), 33 (16.1%) of whom were classified as KDIGO 1, 36 (17.6%) as KDIGO 2, and 113 (55.1%) as KDIGO 3. There was an independent correlation between AKI and the incidence of hyperbilirubinemia and leukocytosis. KDIGO 3 and the need for mechanical ventilation were independently correlated with mortality. We observed a high prevalence of AKI using KDIGO criteria, even in patients with milder forms of leptospirosis. Hyperbilirubinemia and leukocytosis were independent risk factors for AKI. KDIGO 3 was independently associated with mortality.
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Endocarditis due to Burkholderia cepacia and an intracardiac foreign body in a renal transplant patient.

The authors describe the case of a renal transplant patient who developed late infective endocarditis associated with an intracardiac fragment of a catheter inserted 16 years before. Clinical presentation was anemia of undetermined cause and weight loss. Three blood cultures were positive for Burkholderia cepacia. Transesophageal echocardiography revealed a foreign body in the right atrium and right ventricle, confirmed by computed tomography. The patient underwent intravenous antibiotic therapy, followed by cardiac surgery to remove the foreign body. There were no postoperative complications, with improvement of anemia and stabilization of renal function.