Predictive factors of infection in patients with chronic kidney disease using hemodialysis catheters.

Background: Infection is the most frequent complication of central venous catheters used for hemodialysis. Objectives: The purpose of this study was to the determine the central venous catheter-related infection rate at a dialysis center in the Brazilian state of Amazonas and to identify risk factors and the microbiological profile of the infections. Methods: This was an observational study with prospective data collection over a 12-month period by chart analysis and face-to-face interviews with patients undergoing hemodialysis using central venous catheters at a dialysis center. Results: 96 central venous catheters were analyzed in 48 patients. 78 of these were non-tunneled central venous catheters (81.3%) and 18 were tunneled central venous catheters (18.7%), 53.1% of the catheters were exchanged because of infection and blood cultures were obtained from 35.2% of the patients who had catheter-related infections. Gram-negative bacteria were isolated from five of the nine blood cultures in which there was bacterial growth and Gram-positive bacteria were isolated from the other four. The most commonly isolated bacteria was Staphylococcus hominis, found in 22.2% of positive blood cultures. Conclusion: The overall hemodialysis venous catheter infection rate was 10.1 episodes/1000 catheter days, 15.1 episodes/1000 catheters days in non-tunneled catheters and 3.3 episodes/1000 catheters days in tunneled catheters. The infection predisposing factors identified were use of non-tunneled catheters and having 2 hemodialysis sessions per week. Regarding the microbiological profile, over half of the bacteria isolated were Gram-negative.

Effects of an arteriovenous fistula stenosis prevention program in patients receiving hemodialysis.

BACKGROUND: To increase the efficiency of hemodialysis, an appropriate vascular pathway must be created, and its function must be maintained. This study aimed to identify the effects of an arteriovenous fistula (AVF) stenosis prevention program on upper muscular strength, blood flow, physiological indexes, and self-efficacy among patients receiving hemodialysis. METHODS: The participants were patients receiving hemodialysis at Keimyung University Dongsan Medical Center in Daegu, Republic of Korea. They were divided into experimental and control groups based on the day of the week they received hemodialysis at the outpatient department and included 25 participants each. The study was conducted for 8 weeks. RESULTS: The AVF stenosis prevention program was effective in improving upper extremity muscle strength (F=15.23, p<0.001) and blood flow rate (F=36.00, p<0.001). As a result of the program, the phosphorus index level, which is a physiological indicator in hemodialysis patients, decreased (F=8.64, p<0.001). Encouragement and support through text messages and practice lists also resulted in an increase in self-efficacy (F=18.62, p<0.001). CONCLUSION: The AVF stenosis prevention program in this study resulted in an increase in upper extremity muscle strength through grip strength exercises and was effective in preventing AVF stenosis by increasing the blood flow rate.

The effect of positive thinking training on hope and adherence to treatment in hemodialysis patients: a randomized controlled trial.

BACKGROUND: Patients undergoing hemodialysis are exposed to psychological problems, such as despair, which in turn can be a trigger for them to abandon the treatment process. This study aimed to determine the effect of positive thinking training on hope and adherence to treatment in hemodialysis patients. METHODS: This randomized controlled trial was performed on 80 hemodialysis patients referred to two hemodialysis centers in Shiraz, Iran. They were randomly divided into an intervention and a control group. Eight sessions of positive thinking skills training carried out individually on the patients' bedsides. The primary and secondary outcomes were hope and adherence to treatment, respectively. The data were collected using Snyder Hope Questionnaire, End-Stage Renal Disease Adherence Questionnaire, laboratory tests, and weight measurements. Data were analyzed by Chi-square and Paired and Independent T-test using SPSS software version 18. RESULTS: After the intervention, the mean score of hope was significantly higher in the intervention group (42.1 ± 6.1) than in the control group (38.7 ± 6.5) (p = 0.024). Moreover, after the intervention, the mean score of adherence to treatment was significantly higher in the intervention group (1070.2 ± 80.1) compared to the control group (1018.4 ± 105.3) (p = 0.019). In addition, blood urea nitrogen, phosphate and inter-dialytic weight gain were lower in the intervention group compared to the control group after the intervention. CONCLUSIONS: The findings showed that positive thinking interventions could lead to improvement in hope and adherence to treatment in hemodialysis patients. Positive thinking training could be used in caring of hemodialysis patients to improve their hope and adherence to treatment. Trial registration RCT Registry: Iranian Registry of Clinical Trials; RCT registration number: IRCT20180915041044N1; Registration date: 19/12/2018.

Executive summary of the Korean Society of Nephrology 2021 clinical practice guideline for optimal hemodialysis treatment.

The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists' support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient's condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There are also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).

COVID-19 in dialysis units: A comprehensive review.

The coronavirus disease 2019 (COVID-19) pandemic has been challenging for healthcare professionals worldwide. One of the populations affected by the pandemic are patients on renal replacement therapy, as kidney disease is an independent risk factor for severe COVID-19 and maintenance dialysis (a life-sustaining therapy) cannot be interrupted in the vast majority of cases. Over the past months, several authors and medical societies have published recommendations and guidelines on the management of this population. This article is a comprehensive review regarding the measures to prevent, contain and deal with a COVID-19 pandemic in the dialysis setting. We recapitulate the epidemiology and pathophysiology of COVID-19 in kidney dysfunction and present the main recommendations concerning the screening of healthcare personnel, dialysis patients and visitors as well as measures to improve the safety of the dialysis facilities' environments. In addition to preventive measures, this article briefly describes actions directed towards management of an outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within a dialysis facility, the management of complications in dialysis patients with COVID-19 and overall data regarding the management of children with kidney disease.

COVID-19 pandemic in Mexico: surveillance protocol in intrahospital hemodialysis units. / Pandemia COVID-19 en México: protocolo de vigilancia en unidades de hemodiálisis intrahospitalarias.

On January 30 2020, the World Health Organization (WHO) declared the COVID-19 outbreak as epidemiological emergency. Globally, various guidelines have been published for the safety of patients with chronic kidney disease (CKD) and health personnel working in hemodialysis centers. In Mexico, the prevalence of CKD is 12.2% and 60,000 patients receive some modality of renal replacement therapy at the Instituto Mexicano del Seguro Social (IMSS, Mexican Institute for Social Security). This proposal for action is made in the face of suspected and confirmed cases of COVID-19 in intrahospital hemodialysis units.

El 30 de enero de 2020, la Organización Mundial de la Salud (OMS) declaró el brote de COVID-19 como emergencia epidemiológica. A nivel mundial han surgido diversos lineamientos para la seguridad de los pacientes que padecen enfermedad renal crónica (ERC) y el personal de salud que labora en centros de hemodiálisis. En México, la prevalencia de ERC es de 12.2% y 60 000 enfermos reciben alguna modalidad de terapia de reemplazo renal en el Instituto Mexicano del Seguro Social (IMSS). Se realiza esta propuesta de actuación ante casos sospechosos y confirmados de COVID-19 en unidades de hemodiálisis intrahospitalaria.

Fatores preditivos de infecção em pacientes renais crônicos em uso de cateteres venosos centrais / Predictive factors of infection in patients with chronic kidney disease using hemodialysis catheters

Resumo Contexto Infecção é a complicação mais frequente do uso de cateter venoso central em hemodiálise. Objetivo O propósito do trabalho foi determinar a taxa de incidência de infecções de cateteres venosos centrais para hemodiálise em um centro de diálise no estado do Amazonas, bem como seus fatores preditivos, além de traçar o perfil microbiológico dessas infecções. Métodos Trata-se de um estudo observacional, com dados coletados mensalmente e de forma prospectiva, por meio de entrevista e análise de prontuários de pacientes submetidos a hemodiálise por meio de cateteres venosos centrais em um centro de diálise durante um período de 12 meses. Resultados Foram analisados 96 cateteres venosos centrais, de 48 pacientes. Do total, foram 78 cateteres venosos não tunelizados (81,3%) e 18 cateteres venosos tunelizados (18,7%). Dos cateteres acompanhados, 53,1% foram trocados por motivo de infecção, sendo realizada hemocultura de 35,2% dos pacientes que apresentaram infecção de cateter. Quanto ao perfil microbiológico, das nove hemoculturas positivas, em cinco foram isoladas bactérias gram-negativas, e em quatro foram isoladas bactérias gram-positivas. A bactéria mais frequentemente isolada foi a Staphylococcus hominis, presente em 22,2% das hemoculturas positivas. Conclusão A taxa de incidência global de infecção de cateteres venosos centrais foi de 10,1 episódios por 1.000 dias de cateter, sendo de 15,1 nos cateteres não tunelizados e de 3,3 nos cateteres tunelizados. Os fatores preditivos identificados foram o uso de cateter venoso central não tunelizado e a realização de duas sessões de diálise semanais. Quanto ao perfil microbiológico, pouco mais da metade das bactérias isoladas foram gram-negativas.

Abstract Background Infection is the most frequent complication of central venous catheters used for hemodialysis. Objectives The purpose of this study was to the determine the central venous catheter-related infection rate at a dialysis center in the Brazilian state of Amazonas and to identify risk factors and the microbiological profile of the infections. Methods This was an observational study with prospective data collection over a 12-month period by chart analysis and face-to-face interviews with patients undergoing hemodialysis using central venous catheters at a dialysis center. Results 96 central venous catheters were analyzed in 48 patients. 78 of these were non-tunneled central venous catheters (81.3%) and 18 were tunneled central venous catheters (18.7%), 53.1% of the catheters were exchanged because of infection and blood cultures were obtained from 35.2% of the patients who had catheter-related infections. Gram-negative bacteria were isolated from five of the nine blood cultures in which there was bacterial growth and Gram-positive bacteria were isolated from the other four. The most commonly isolated bacteria was Staphylococcus hominis, found in 22.2% of positive blood cultures. Conclusion The overall hemodialysis venous catheter infection rate was 10.1 episodes/1000 catheter days, 15.1 episodes/1000 catheters days in non-tunneled catheters and 3.3 episodes/1000 catheters days in tunneled catheters. The infection predisposing factors identified were use of non-tunneled catheters and having 2 hemodialysis sessions per week. Regarding the microbiological profile, over half of the bacteria isolated were Gram-negative.

Fatores associados à autoavaliação de saúde bucal por adultos em hemodiálise / Factors associated with self-rated oral health in adults with hemodialysis

Resumo Introdução Pacientes com insuficiência renal crônica podem apresentar prejuízos em sua saúde bucal em decorrência da própria doença, do tratamento e das alterações de estilo de vida associadas. Objetivo Avaliar os fatores associados à autoavaliação de saúde bucal ruim entre adultos com insuficiência renal crônica submetidos à hemodiálise. Método Estudo transversal com 243 adultos submetidos à hemodiálise em um hospital do sul de Minas Gerais nos anos de 2013 e 2014. O desfecho foi avaliado pelo autorrelato da condição bucal dicotomizada em boa (ótima/boa) e ruim (regular/ruim/péssima). As variáveis independentes incluíram condições sociodemográficas, saúde geral, saúde bucal e uso de serviços odontológicos, a partir de informações coletadas por meio de questionário. A associação entre o desfecho e as variáveis independentes foi testada por meio de modelos logísticos múltiplos com inclusão hierarquizada de variáveis. Resultados A prevalência de autoavaliação de saúde bucal ruim foi de 35,4%. Os mais jovens (p = 0,015), os que se submetem à hemodiálise há menos tempo (p = 0,016), têm halitose (p <0,001), necessitam de tratamento odontológico (p <0,001) e tiveram a última consulta odontológica por motivo diferente de dor (p = 0,027) expressaram maiores chances de autoavaliação de saúde bucal ruim, independentemente de condições sociodemográficas e de saúde. Conclusão Condições sociodemográficas, tempo em hemodiálise, agravos à saúde bucal e uso de serviços odontológicos influenciaram a autoavaliação da saúde bucal dos adultos submetidos à hemodiálise.

Abstract Background Patients with chronic renal failure may have their oral health impaired as a result of the disease itself, its treatment, and its associated lifestyle alterations. Objective To assess the factors associated with poor self-rated oral health among adults with chronic renal failure treated by hemodialysis. Method This is a cross-sectional study with 243 adults undergoing hemodialysis in a hospital in Minas Gerais, Brazil in 2013-2014. The outcome was assessed by the self-report of oral health categorized into good (excellent/good) and bad (fair/bad / very bad). The independent variables included sociodemographic conditions, general health, oral health, and the use of dental services were collected through a structured questionnaire. The association between the outcome and the independent variables was tested using multiple logistic models with hierarchical inclusion of variables. Results The prevalence of poor self-rated oral health was 35.4%. The youngest (p = 0.015), those who have undergone hemodialysis in the shortest time (p = 0.016), have halitosis (p <0.001), need dental treatment (p <0.001), and had their last dental appointment not for pain (p = 0.027) expressed higher odds of poor self-rated oral health, independently of sociodemographic and health conditions. Conclusion Sociodemographic conditions, time on hemodialysis, oral impairments, and use of dental services affected the oral health self-assessment among adults undergoing hemodialysis.

Which dialysis unit blood pressure is the most accurate for predicting home blood pressure in patients undergoing hemodialysis?

BACKGROUND/AIMS: We investigated which dialysis unit blood pressure (BP) is the most useful for predicting home BP in patients undergoing hemodialysis (HD). METHODS: Patients undergoing HD who had been treated > 3 months were included in this study. Exclusion criteria were hospitalized patients with acute illness and changes in dry weight and anti-hypertensive drugs 2 weeks before the study. We used the dialysis unit BP recording data, such as pre-HD, intra-HD, post-HD, mean pre-HD, and post-HD (pre-post-HD), mean pre-HD, intra-HD, and post-HD (pre-intra-post-HD) BP. Home BP (the same period of dialysis unit BP) was monitored as a reference method during 2 weeks using the same automatic oscillometric device. Patients were asked to record their BP three times daily (wake up, between noon and 6:00 PM, and at bedtime). RESULTS: Significant differences were detected between home systolic blood pressure (SBP) and pre-HD, post-HD, and intra-HD SBP (p = 0.003, p = 0.001, p = 0.016, respectively). In contrast, no differences were observed between home SBP and pre-intra-post-HD and pre-post-HD SBP (p = 0.235, p = 0.307, respectively). Areas under the receiver operating characteristic curve for pre-intra-post-HD and prepost-HD SBP with 2-week home BP as the reference standard were 0.812 and 0.801, respectively. CONCLUSIONS: These results suggest that pre-intra-post-HD and pre-post-HD SBP had similar accuracy for predicting mean 2-week home SBP in HD patients. Therefore, pre-intra-post-HD and pre-post-HD SBP should be useful for predicting home SBP in HD patients if ambulatory or home BP measurements are unavailable.

Hemodiálisis vs Hemodiafiltración en línea / Hemodialysis vs Hemodiafiltration online

INTRODUCCIÓN. La incorporación de nuevas tecnologías como la hemodiafiltración en línea, han mejorado parámetros metabólicos/nutricionales en los pacientes que se encontraban en hemodiálisis convencional; en la actualidad no existen datos registrados en la población ecuatoriana que se encuentra sometida a esta clase de tecnologías. OBJETIVO. Comparar la evolución clínico-metabólica de pacientes que estaban en hemodiálisis convencional y cambiaron a hemodiafiltración en línea, determinar si es favorable la migración de la terapia hemodialítica difusiva a convectiva y establecer si el cambio de terapia dialítica ocasionó resultados favorables. MATERIALES Y MÉTODOS. Estudio analítico retrospectivo. Población y muestra de 38 pacientes enfermos renales crónicos en terapia de sustitución renal modalidad hemodiálisis convencional que cambiaron a hemodiafiltración en línea, independientemente del tiempo de diagnóstico y tratamiento en la unidad de hemodiálisis del Hospital de Especialidades Carlos Andrade Marín, Quito-Ecuador, durante el periodo marzo 2016 a marzo 2017. RESULTADOS. Los efectos nutricionales y metabólicos pudieron denotar mayor ponderación de resultados favorables en la modalidad de hemodiafiltración. En la estabilidad hemodinámica y la dosis de diálisis se evidenció una leve superioridad en la modalidad de hemodiafiltración en comparación a la Hemodiálisis. En las dosis administradas de Calcio, Hierro, Eritropoyetina y Calcitriol no existieron diferencias significativas entre las dos modalidades de tratamientos. CONCLUSIÓN. El cambio de modalidad de Hemodiálisis convencional a Hemodiafiltración en línea fue favorable, y mejoró los parámetros clínicos/metabólicos de los pacientes que requieren terapia de sustitución renal.

INTRODUCTION. The incorporation of new technologies such as online haemodiafiltration have improved metabolic/nutritional parameters in patients who were on conventional haemodialysis; At present, there are no registered data on the Ecuadorian population that is subjected to this kind of technology. OBJECTIVE. To compare the clinical-metabolic evolution of patients who were on conventional hemodialysis and changed to online hemodiafiltration, to determine if the migration from diffusive to convective hemodialysis therapy is favorable and to establish if the change in dialysis therapy caused favorable results. MATERIALS AND METHODS. Retrospective analytical study. Population and sample of 38 patients with chronic kidney disease in conventional hemodialysis modality renal replacement therapy who changed to online hemodiafiltration, regardless of the time of diagnosis and treatment in the hemodialysis unit of the Hospital de Especialidades Carlos Andrade Marín, Quito-Ecuador, during the period March 2016 to March 2017. RESULTS. The nutritional and metabolic effects could denote a greater weighting of favorable results in the hemodiafiltration modality. In hemodynamic stability and dialysis dose, a slight superiority was evidenced in the hemodiafiltration modality compared to hemodialysis. In the administered doses of Calcium, Iron, Erythropoietin and Calcitriol there were no significant differences between the two treatment modalities. CONCLUSION. The change of modality from conventional hemodialysis to online hemodiafiltration was favorable, and improved the clinical/metabolic parameters of patients requiring renal replacement therapy.

Cuidados de enfermagem na hemodiálise / Nursing care in hemodialysis / Cuidados de enfermeria en la hemodiálisis

Objetivo: Identificar os cuidados de enfermagem realizados ao paciente em hemodiálise. Método: Revisão integrativa da produção científica brasileira sobre a temática do cuidado de enfermagem em hemodiálise produzida nos últimos dez anos, disponíveis na base de dados do Banco de Teses da Coordenação de Aperfeiçoamento Pessoal de Nível Superior. Para a avaliação da informação os autores elaboraram um instrumento com três variáveis relacionadas à questão que norteia o estudo. Resultados: A amostra final foi constituída por 22 estudos. Identificou-se um total de sete temáticas: relacionamento interpessoal, educação em saúde, cuidado centrado no paciente, cuidado da ingesta, cuidado do acesso venoso, adaptação à hemodiálise e segurança do paciente respetivamente. Conclusão: Ressalta-se a necessidade de um aprofundamento por parte de enfermagem no cuidado a partir das subjetividades que contextualizam ao paciente inserido em hemodiálise

Objective: To identify the nursing care provided to patients on hemodialysis. Method: An integrative review of the Brazilian scientific production on the theme of hemodialysis nursing care produced in the last ten years, available in the Database of Theses Database of the Higher Education Personal Improvement Coordination. To evaluate the information, the authors elaborated an instrument with three variables related to issue that guides the study. Results: The final sample consisted of 22 studies. A total seven themes were identified: interpersonal relationship, health Education, patient-centered care, care of the ingestions, care of venous access, adaptation to hemodialysis and patient safety respectively. Conclusion: The need for deepening on the part of nursing care is emphasized based on the subjectivities that contextualize the patient inserted in hemodialysis

Objetivo: Identificar los cuidados de enfermería realizados al paciente en hemodiálisis. Método: Revisión integrativa de la producción científica brasileña sobre la temática del cuidado de enfermería en hemodiálisis producida en los últimos diez años, disponibles en la base de datos de Banco de tesis de la Coordinación de Perfeccionamiento Personal de nivel superior. Para evaluar la información los autores diseñaron un instrumento con tres variables relacionadas a la pregunta norteadora de este estudio. Resultados: La muestra final fue constituida por 22 estudios. Se identificó un total de siete temáticas: relacionamiento interpersonal, educación en salud, cuidado centrado en el paciente, cuidado de la ingesta, cuidado del acceso venoso, adaptación a la hemodiálisis y seguridad del paciente respectivamente. Conclusión: Resalta la necesidad de una profundización por parte de enfermería en relación al cuidado a partir de las subjetividades que contextualizan al paciente insertado en hemodiálisis

Calidad del sueño en pacientes con enfermedad renal crónica / Sleep quality in patients with chronic kidney disease

Introducción: los pacientes con enfermedad renal crónica (ERC), y en específico los que tienen tratamiento renal sustitutivo (TRS), se ven afectados en su ciclo circadiano y en su calidad del sueño. Objetivo: evaluar la calidad del sueño de los pacientes con enfermedad renal crónica que acuden al servicio de Nefrología de una unidad médica de segundo nivel de atención. Metodología: estudio comparativo en pacientes con ERC del servicio de Nefrología, clasificados en tres grupos, dos de ellos en terapia de reemplazo renal (diálisis peritoneal y hemodiálisis) y uno sin terapia de reemplazo renal (prediálisis). Para la calidad del sueño se utilizó la escala de Pittsburgh, se incluyeron datos sociodemográficos y parámetros bioquímicos. Los datos se analizaron median- te comparación de frecuencias con Chi cuadrada, medias con t de Student y ANOVA de un factor. Resultados: se formaron tres grupos: hemodiálisis (n = 75), diálisis peritoneal (n = 58) y prediálisis (n = 71). La edad media fue de 53.5 años; la calidad subjetiva del sueño fue buena en el 48% del total y en el 54.9% de los pacientes en prediálisis (p < 0.05). Al aplicar la escala de Pittsburgh, el 80.4% del total y el 84.5% de los pacientes en diálisis reportaron una calidad de sueño mala. De las siete dimensiones evaluadas, dos fueron diferentes en los tres grupos (p < 0.05). Conclusiones: la percepción del paciente sobre la calidad del sueño habitualmente se sobreestima, lo que indica una adaptación a un sueño ineficiente. Debido a las características de estos pacientes es importante mantener un control de sus parámetros bioquímicos, que también tienen un impacto en la calidad del sueño.

Introduction: In patients with chronic kidney disease (CKD) and specifically with renal replacement therapy (RRT), their circadian cycle and consequently their sleep quality are affected. Objective: To evaluate the quality of sleep in patients with chronic kidney disease attends at the nephrology service. Methods: Comparative study in patients with chronic kidney disease from the nephrology service classified into three groups, two of them had renal replacement therapy (peritoneal dialysis and hemodialysis) and one without renal replacement therapy (predialysis). For the quality of sleep we used the Pittsburgh Scale, sociodemographic data and biochemical parameters were included. Comparison of frequencies with chi-square, means with Student's t and Anova of one factor. Results: Three groups were formed: hemodialysis (n = 75), peritoneal dialysis (n = 58) and predialysis (n = 71). The mean age was 53.5 years; the subjective quality of sleep was "good" in 48.0% of the total and in 54.9% of predialysis patients (p <0.05). When applying the Pittsburgh scale, 80.4% of the total and 84.5 of the dialysis patients reported a "poor" quality of sleep. Of the seven dimensions evaluated, two were different in the three groups (p < 0.05) Conclusions: The patient's perception of the quality of sleep is regularly overestimated, which indicates an adaptation to this dream habit. Due to the characteristics of these patients, it is important to keep a check on their biochemical parameters, which also have an impact on the quality of sleep.

Custo direto da inserção de cateter venoso central para realização de hemodiálise convencional / Costo directo de la inserción de catéter venoso central para realización de la hemodiálisis convencional / Direct cost of central venous catheter insertion for conventional hemodialysis

RESUMO Objetivo: identificar o custo direto médio da inserção de cateter venoso central de longa permanência em pacientes submetidos à hemodiálise convencional em um hospital público de ensino e pesquisa. Método: pesquisa quantitativa, exploratório-descritiva, realizada em um Centro de Diálise, em São Paulo, Brasil entre novembro e dezembro/2019. Calculou-se o custo direto médio multiplicando-se o tempo despendido por profissionais de saúde pelo custo unitário da mão de obra direta, somando-se aos custos de insumos. Resultados: o custo direto médio total correspondeu a US$134,56 (DP±3,65), sendo US$107,01 (DP±0,23) relativos ao custo com material, US$22,10 (DP±3,63) com a mão de obra direta da equipe de inserção do cateter, US$4,65 (DP±0,00) com custo de medicamentos e US$0,80 (DP±0,15) com custo de soluções. Conclusão: constatou-se o impacto dos custos com recursos materiais e a imprescindibilidade da sua alocação racional, especialmente nos hospitais públicos de ensino e pesquisa, que possuem recursos financeiros limitados.

RESUMEN Objetivo: identificar el costo directo de la inserción de catéteres venosos centrales de larga duración en pacientes sometidos a hemodiálisis convencional en un hospital público de enseñanza e investigación. Método: investigación cuantitativa exploratoria-descriptiva realizada en un Centro de Diálisis de São Paulo, Brasil, entre noviembre y diciembre/2019. El costo directo medio se calculó multiplicando el tiempo empleado por los profesionales de la salud por el costo unitario de la mano de obra directa, sumando los costos de los insumos. Resultados: el costo directo medio total fue de 134,56 dólares (SD±3,65), de los cuales 107,01 dólares (SD±0,23) fueron costos de material, 22,10 dólares (SD±3,63) fueron costos de mano de obra directa del equipo de inserción de catéteres, 4,65 dólares (SD±0,00) fueron costos de medicación y 0,80 dólares (SD±0,15) fueron costos de solución. Conclusión: se ha constatado el impacto de los costos de los recursos materiales y la importancia de su asociación racional, especialmente en los hospitales públicos de enseñanza e investigación, que cuentan con recursos financieros limitados.

ABSTRACT Objective: to identify the average direct cost of long-term central venous catheter insertion in patients undergoing conventional hemodialysis in a public teaching and research hospital. Method: quantitative, exploratory-descriptive research, conducted in a Dialysis Center in São Paulo, Brazil between November and December/2019. The average direct cost was calculated by multiplying the time spent by health professionals by the unit cost of direct labor, adding to the costs of inputs. Results: The average total direct cost was US$134.56 (SD±3.65), of which US$107.01 (SD±0.23) for material costs, US$22.10 (SD±3.63) for direct labor of the catheter insertion team, US$4.65 (SD±0.00) for medication costs, and US$0.80 (SD±0.15) for solution costs. Conclusion: the impact of costs with material resources and the indispensability of their rational allocation was verified, especially in public teaching and research hospitals, which have limited financial resources.

Factors related to hemodialysis safety culture: integrative literature review / Factores relacionados con la cultura de seguridad en hemodiálisis: revisión de literatura integradora / Fatores relacionados à cultura de segurança em hemodiálise: revisão integrativa da literatura

ABSTRACT Objective: To analyze the factors involved in nursing care that are related to the safety culture of chronic renal patients on hemodialysis. Method: Integrative literature review, carried out through the steps: problem identification, bibliographic research, data evaluation, data analysis, and report. We adopted the guiding question: "What scientific evidence is there about the factors related to the safety culture in hemodialysis clinics, according to the nursing team?" The search was carried out in the LILACS, Medline / PUBMED, Scopus, CINAHL, Cochrane, and Web of Science (WOS) databases. Results: The sample of this review was composed of five studies. The factors found were: 8 predisposing, 13 disabling, 11 precipitating, and 18 reinforcing. Conclusion: The analysis of literary productions allowed an understanding of the main factors linked to nursing practices that influence the safety culture of patients on hemodialysis.

RESUMEN Objetivo: Analizar los factores envueltos en la asistencia de enfermaría que están relacionados a la cultura de seguridad de pacientes renales crónicos en tratamiento hemodialítico. Método: Revisión integrativa de la literatura, realizada mediante las etapas: identificación del problema, investigación bibliográfica, evaluación de los datos, análisis de los datos e informe. Se ha optado la cuestión orientadora: "¿Cuales evidencias científicas existentes sobre los factores relacionados a la cultura de seguridad en clínicas de hemodiálisis, segundo el equipo de enfermaría?" La búsqueda ha sido realizada en las bases de datos LILACS, Medline/PUBMED, Scopus, CINAHL, Cochrane y Web of Science (WOS). Resultados: La muestra de esta revisión ha sido compuesta por cinco estudios. Los factores encontrados han sido: 8 predisponentes, 13 discapacidades, 11 precipitantes y 18 reforzadores. Conclusión: El análisis de las producciones literarias ha permitido comprensión de los principales factores relacionados a las conductas de enfermaría que influencian en la cultura de seguridad del paciente en tratamiento hemodialítico.

RESUMO Objetivo: Analisar os fatores envolvidos na assistência de enfermagem que estão relacionados à cultura de segurança de pacientes renais crônicos em tratamento hemodialítico. Método: Revisão integrativa da literatura, realizada mediante as etapas: identificação do problema, pesquisa bibliográfica, avaliação dos dados, análise dos dados e relatório. Adotou-se a questão norteadora: "Quais evidências científicas existem sobre os fatores relacionados à cultura de segurança em clínicas de hemodiálise, segundo a equipe de enfermagem?" A busca foi realizada nas bases de dados LILACS, Medline/PUBMED, Scopus, CINAHL, Cochrane e Web of Science (WOS). Resultados: A amostra desta revisão foi composta por cinco estudos. Os fatores encontrados foram: 8 predisponentes, 13 incapacitantes, 11 precipitantes e 18 reforçadores. Conclusão: A análise das produções literárias permitiu compreensão dos principais fatores ligados às condutas de enfermagem que influenciam na cultura de segurança do paciente em tratamento hemodialítico.

Evolución del fracaso renal agudo en pacientes críticos hemodializados / Evolution of acute renal failure in critical hemodialysis patients

RESUMEN Introducción: el fracaso renal agudo es un síndrome clínico secundario a múltiples etiologías, se caracteriza por el deterioro brusco de la función renal, potencialmente reversible con una elevada morbimortalidad en las unidades de cuidados intensivos. Investigar el comportamiento de esta afección permitirá elaborar protocolos de actuación precoz para evitar el desenlace fatal o el ingreso a programa de hemodiálisis crónica. Objetivo: determinar el comportamiento clínico y epidemiológico del fracaso renal agudo en pacientes críticos hemodializados. Métodos: se realizó un estudio descriptivo, retrospectivo en la unidad de cuidados intensivos del Hospital General Docente Abel Santamaría Cuadrado de Pinar del Río desde agosto de 2016 a julio del 2017. El universo estuvo constituido por 486 pacientes que presentaron fracaso renal agudo y la muestra por los 97 pacientes que se hemodializaron en el periodo estudiado. Resultados: predominó el sexo masculino (61,86 %) y edades mayores de 61 años (21,63 %). La sepsis fue la causa de fracaso renal agudo más frecuente (46,39 %) y el prerrenal según su origen fisiopatológico (88,58%) con predominio de los no oligúricos (54,59 %). De los pacientes con diagnóstico de fracaso renal agudo prerrenal el 38,11 % requirió entre ocho a 14 hemodiálisis y la mayoría de las renales necesitaron 21 sesiones o más. Más de la mitad de los pacientes fallecieron (56,70 %), de ellos el 16,48 % tenía entre 61 y 70 años, el 16,50 % requirió hemodiálisis crónica. Conclusiones: el fracaso renal agudo prerrenal con requerimiento de hemodiálisis y la evolución a la muerte fue el comportamiento del fracaso renal agudo en los pacientes estudiados.

ABSTRACT Introduction: acute renal failure is a clinical syndrome, secondary to multiple etiologies; it is characterized by the abrupt deterioration of renal function, potentially reversible with high morbidity and mortality in Intensive Care Units. To examine the behavior of this condition will allow the development of protocols of the early intervention, to avoid the fatal outcomes or the admission to the chronic hemodialysis program. Objective: to determine the clinical and epidemiological behavior of acute renal failure in critically-ill hemodialysis patients. Methods: a descriptive, retrospective study was conducted in the Intensive Care Unit at Abel SantamaríaCuadrado General Teaching Hospital in Pinar del Rio, from August 2016 to July 2017. The target group included 486 patients suffering from acute renal failure and the sample comprised 97 patients who underwent hemodialysis in the period studied. Results: male sex prevailed (61,86 %) and ages over 61 years (21,63 %). Sepsis was the most frequent cause of acute renal failure (46.39 %) and the pre-renal one according to its pathophysiologicalorigin (88,58%), with predominance of non-oligouric (54,59 %). Out of the patients with a diagnosis of pre-renal acute renal failure, 38,11 % required between 8 and 14 hemodialysis procedures, and the majority of the renal patients needed 21 or more sessions. More than the half of patients died (56,70 %), of them 16,48 % were between 61 and 70 years old, 16,50 % required iterated hemodialysis. Conclusions: pre-renal and renal failure with hemodialysis requirement and evolution to death.was the behavior of acute renal failure in the patients studied.

Pseudoaneurisma trombosado en fístula arteriovenosa autóloga / Thrombosed pseudo-aneurysm in autologous arteriovenous fistula

RESUMEN 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. Reporte de 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.

ABSTRACT Introduction: the arteriovenous-autologous fistula is the optimal vascular access for patients undergoing hemodialysis, since its preparation, maturity stage and use of it can include several complications, being pseudo-aneurysm on arteriovenous-autologous fistulas one of the infrequent complications. Case report: a 40-year-old male patient with a history of hypertension, cerebral aneurysm, and chronic renal failure undergoing hemodialysis is presented, using an arteriovenous-autologous fistula as a pathway that developed a pseudo-aneurysm. Clinical and surgical characteristics related to this case are exposed. Conclusions: the case of a patient with thrombosed pseudo-aneurysm developed on arteriovenous-autologous fistula was reported, an infrequent complication but its surgical resolution allowed prolonging the useful life of the vascular access.

A call-to-action for sustainability in dialysis in Brazil / Um apelo pela sustentabilidade na diálise no Brasil

ABSTRACT Human-induced climate change has been an increasing concern in recent years. Nephrology, especially in the dialysis setting, has significant negative environmental impact worldwide, as it uses large amounts of water and energy and generates thousands of tons of waste. While our activities make us responsible agents, there are also several opportunities to change the game, both individually and as a society. This call-to-action intends to raise awareness about environmentally sustainable practices in dialysis and encourages this important discussion in Brazil.

RESUMO A mudança climática induzida pela atividade humana tem sido foco de preocupações crescentes nos últimos anos. A nefrologia, particularmente a diálise, produz significativos impactos ambientais em todo o mundo em virtude da grande utilização de água e energia e da geração de milhares de toneladas de resíduos. Embora nossas atividades nos tornem agentes responsáveis, há várias oportunidades para mudar esse cenário, tanto individualmente como em sociedade. O presente artigo pretende ampliar a conscientização sobre práticas ambientalmente sustentáveis em diálise e estimular essa importante discussão no Brasil.

Levamisole usage as an adjuvant to hepatitis B vaccine in hemodialysis patients, yes or no?

BACKGROUND: Hepatitis B virus (HBV) infection is much more common in hemodialysis patients than the general population. These patients have an impaired immune response to HBV vaccination; to that end there are certain studies that have evaluated levamisole as an immunomodulator agent improving HBV vaccination response rate in hemodialysis patients. OBJECTIVES: In the current review, we have assembled all of the results to determine whether lavamisole is of value as an adjuvant to HBV vaccination in hemodialysis patients. MATERIALS AND METHODS: Science Direct (Elsevier), ProQuest, Springer, MD Consult, BMJ Journals, Pubmed and Wiley were searched for levamisole application to HBV vaccination in hemodialysis patients. All studies revealed a seroconversion response level between levamisole plus HBV vaccine versus HBV vaccine alone. RESULTS: From 10 relevant studies, 5 studies fulfilled our inclusion criteria. Three of them suggested the significant benefit of adding levamisole to the HBV vaccine to increase augment seroprotection level in hemodialysis patients. Another study reported a decrease in seroprotection level and another study showed no significant difference caused by levamisole administration. CONCLUSIONS: Due to the limited number of studies evaluated, it is challenging to perform a definite decision about routinely administering levamisole in addition to the HBV vaccine for all hemodialysis patients. However, it does seem reasonable to recommend administration of levamisole for impaired immune response patients.

Aspectos de interesse e preparo dos enfermeiros de terapia intensiva sobre injúria renal aguda / Aspects of interest and preparation of intensive therapy nurses to act in the care of acute kidney injury / Aspectos de interés y preparación de enfermeros de cuidados intensivos sobre lesión renal aguda

Objetivou-se avaliar os aspectos de interesse e preparo de enfermeiros de terapia intensiva para atuar no cuidado a pacientes com injúria renal aguda. Trata-se de estudo transversal, avaliativo, realizado em sete hospitais públicos, com 136 enfermeiros, sendo avaliados o interesse e o preparo sobre o cuidado a pacientes com injúria renal aguda em terapia intensiva. A análise inferencial foi realizada por meio do teste qui-quadrado. Evidenciouse elevado interesse em aprender sobre a temática (n=125), sobre a gestão das máquinas (n=119) e em participar de curso teórico ou prático (n=126), visto que se sentem despreparados (n=88) e mencionam insegurança (n=111) em cuidar dos pacientes com injúria renal aguda. Não houve treinamento na admissão específico para a hemodiálise (n=136) e somente cinco enfermeiros relataram treinamento oferecido pela instituição. O interesse em aprender sobre a temática é elevado, no entanto, o preparo ainda é incipiente, o que demonstra a necessidade de mais investimentos em ações de capacitação ofertadas pela instituição voltadas para o enfermeiro intensivista que presta cuidado ao paciente com injúria renal aguda.(AU)

The objective of this study was to evaluate the aspects of interest and preparation of intensive care nurses to act in the care of patients with acute kidney injury. This cross-sectional, evaluative study was carried out in seven public hospitals, with 136 nurses. The interest and preparation to provide care for patients with acute kidney injury in intensive care were evaluated. Inferential analysis was performed using the chi-square test. There was a high interest in learning about the subject (n = 125) and about the management of the machines (n = 119) and in participating in theoretical or practical courses (n = 126), because they felt unprepared (n = 88) and mentioned insecurity (n = 111) to provide care for patients with acute kidney injury. There was no specific training when assigned to the hemodialysis sector (n = 136), and only five nurses reported that the institution offers training. The interest in learning about the theme is high. However, the preparation is still incipient and indicates the need for more investments in training by the institution directed to intensive care nurses who provide care to patients with acute kidney injury.

Direct costs of integrated procedures of conventional hemodialysis performed by nursing professionals / Custos diretos de procedimentos integrantes da hemodiálise convencional realizada por profissionais de enfermagem / Costos directos de procedimientos integrantes de la hemodiálisis convencional realizada por profesionales de enfermería

ABSTRACT Objective: to analyze the mean direct cost of the constituent procedures of conventional hemodialysis, performed in three public teaching and research hospitals. Method: quantitative, exploratory-descriptive study, of the multiple case study type. The mean direct cost was calculated by multiplying the time (timed) spent by nursing professionals, on the execution of procedures, by the unit cost of direct labor, added to the cost of materials and solutions/medications. Results: the total mean direct cost, in patients with an arteriovenous fistula corresponded to US$25.10 in hospital A, US$37.34 in hospital B and US$25.01 in hospital C, and in patients with a dual lumen catheter, US$32.07 in hospital A, US$40.58 in hospital B and US$30.35 in hospital C. The weighted mean values obtained were US$26.59 for hospital A, US$38.96 for hospital B and US$27.68 for hospital C. It was noted that the "installation and removal of hemodialysis fistula access" caused a significantly lower economic impact compared to "installation and removal of hemodialysis catheter access". Conclusion: with the knowledge developed it will be possible to support hospital managers, technical managers and nursing professionals in the decision making process, with a view to the rational allocation of the necessary inputs for the performance of conventional hemodialysis.

RESUMO Objetivo: analisar o custo direto médio de procedimentos constituintes da hemodiálise convencional, realizada em três hospitais públicos de ensino e pesquisa. Método: pesquisa quantitativa, exploratório-descritiva, do tipo estudos de casos múltiplos. Calculou-se o custo direto médio por meio da multiplicação do tempo (cronometrado) despendido por profissionais de enfermagem, na execução dos procedimentos, pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais e soluções/medicamentos. Resultados: o custo direto médio total, em pacientes portadores de fístula arteriovenosa, correspondeu a US$25.10 no hospital A, US$37.34 no hospital B e US$25.01 no hospital C e, em pacientes com cateter de duplo lúmen, US$32.07 no hospital A, US$40.58 no hospital B e US$30.35 no hospital C. As médias ponderadas dos valores obtidos foram US$26.59 para o hospital A, US$38.96 para o hospital B e US$27.68 para o hospital C. Evidenciou-se que a "instalação e desinstalação de hemodiálise via fístula" causou impacto econômico significativamente menor em comparação à "instalação e desinstalação de hemodiálise via cateter". Conclusão: com o conhecimento desenvolvido será possível subsidiar gerentes hospitalares, responsáveis técnicos e profissionais de enfermagem no processo decisório, com vistas à alocação racional dos insumos necessários à consecução da hemodiálise convencional.

RESUMEN Objetivo: analizar el costo directo promedio de procedimientos constituyentes de la hemodiálisis convencional, realizada en tres hospitales públicos de enseñanza e investigación. Método: investigación cuantitativa, exploratoria y descriptiva, del tipo estudios de casos múltiples. Se calculó el costo directo promedio por medio de la multiplicación del tiempo (cronometrado) utilizado por profesionales de enfermería, en la ejecución de los procedimientos, por el costo unitario de la mano de obra directa, sumándolo al costo de los materiales y soluciones/medicamentos. Resultados: el costo directo promedio total, en pacientes con fístula arteriovenosa, correspondió a US$ 25,10 en el hospital A, US$ 37,34 en el hospital B y US$ 25,01 en el hospital C; y, en pacientes con catéter de doble lumen, US$ 32,07 en el hospital A, US$ 40,58 en el hospital B y US$ 30,35 en el hospital C. Los promedios ponderadas de los valores obtenidos fueron US$ 26,59 para el hospital A, US$ 38,96 para el hospital B y US$ 27,68 para el hospital C. Se evidenció que la "instalación y desinstalación de la hemodiálisis vía fístula" causó impacto económico significativamente menor en comparación a la "instalación y desinstalación de la hemodiálisis vía catéter". Conclusión: con el conocimiento desarrollado será posible auxiliar administradores hospitalarios, responsables técnicos y profesionales de enfermería, en el proceso decisorio, con el objetivo de distribuir racionalmente los insumos necesarios a la consecución de la hemodiálisis convencional.