The influence of hemodialysis on intracranial pressure waveform in patients with chronic kidney disease: an observational study.

BACKGROUND: Among the complications related to chronic kidney disease (CKD), those of a neurological nature stand out, and for a better quality of life for patients, the diagnosis and treatment of these complications is fundamental. OBJECTIVES: This study aimed to assess the effect of hemodialysis on intracranial pressure waveform (ICPw) in patients with chronic kidney disease undergoing hemodialysis and those who are not yet undergoing substitutive therapy. DESIGN AND SETTING: An observational study was conducted in two stages at a kidney replacement therapy center in Brazil. The first was a longitudinal study and the second was a cross-sectional study. METHODS: Forty-two patients on hemodialysis were included in the first stage of the study. In the second stage, 226 participants were included. Of these, 186 were individuals with chronic kidney disease (who were not undergoing substitutive therapy), and 40 did not have the disease (control group). The participants' intracranial compliance was assessed using the non-invasive Brain4care method, and the results were compared between the groups. RESULTS: There was a significant difference between the hemodialysis and non-hemodialysis groups, with the former having better ICPw conditions. CONCLUSIONS: Hemodialysis influenced the improvement in ICPw, probably due to the decrease in the patients' extra-and intracellular volumes. Furthermore, ICPw monitoring can be a new parameter to consider when defining the moment to start substitutive therapy.

Inflammation and the peritoneal membrane: causes and impact on structure and function during peritoneal dialysis.

Peritoneal dialysis therapy has increased in popularity since the end of the 1970s. This method provides a patient survival rate equivalent to hemodialysis and better preservation of residual renal function. However, technique failure by peritonitis, and ultrafiltration failure, which is a multifactorial complication that can affect up to 40% of patients after 3 years of therapy. Encapsulant peritoneal sclerosis is an extreme and potentially fatal manifestation. Causes of inflammation in peritoneal dialysis range from traditional factors to those related to chronic kidney disease per se, as well as from the peritoneal dialysis treatment, including the peritoneal dialysis catheter, dialysis solution, and infectious peritonitis. Peritoneal inflammation generated causes significant structural alterations including: thickening and cubic transformation of mesothelial cells, fibrin deposition, fibrous capsule formation, perivascular bleeding, and interstitial fibrosis. Structural alterations of the peritoneal membrane described above result in clinical and functional changes. One of these clinical manifestations is ultrafiltration failure and can occur in up to 30% of patients on PD after five years of treatment. An understanding of the mechanisms involved in peritoneal inflammation is fundamental to improve patient survival and provide a better quality of life.

Acute Kidney Injury with Neurological Features: Beware of the Star Fruit and its Caramboxin.

Star fruit (Averrhoa carambola) is a well-known product in tropical countries. There are few reports published in literature with acute kidney injury due to oxalate induced nephropathy. However, none of them have an important neurological feature. We present a case of a 51-year-old male with paresis and altered mental status. Screening for neurological diseases such as stroke, Guillain-Barre, meningitis and encephalitis were negative. In the evolution, he developed acute kidney failure and was submitted to 4 dialysis sessions. After talking to the family, we discovered he had ingested over 50 star fruits prior to the acute neurologic deficits. He recovered renal function so a renal biopsy was not required. Physicians should actively look for star fruit ingestion history in patients presenting with unexplained acute kidney injury with or without neurological features. Besides, taking star fruit in a large amount, accompanied by an empty stomach and dehydrated state, is a risk factor for neurotoxicity.

The influence of hemodialysis on intracranial pressure waveform in patients with chronic kidney disease: an observational study

ABSTRACT BACKGROUND: Among the complications related to chronic kidney disease (CKD), those of a neurological nature stand out, and for a better quality of life for patients, the diagnosis and treatment of these complications is fundamental. OBJECTIVES: This study aimed to assess the effect of hemodialysis on intracranial pressure waveform (ICPw) in patients with chronic kidney disease undergoing hemodialysis and those who are not yet undergoing substitutive therapy. DESIGN AND SETTING: An observational study was conducted in two stages at a kidney replacement therapy center in Brazil. The first was a longitudinal study and the second was a cross-sectional study. METHODS: Forty-two patients on hemodialysis were included in the first stage of the study. In the second stage, 226 participants were included. Of these, 186 were individuals with chronic kidney disease (who were not undergoing substitutive therapy), and 40 did not have the disease (control group). The participants' intracranial compliance was assessed using the non-invasive Brain4care method, and the results were compared between the groups. RESULTS: There was a significant difference between the hemodialysis and non-hemodialysis groups, with the former having better ICPw conditions. CONCLUSIONS: Hemodialysis influenced the improvement in ICPw, probably due to the decrease in the patients' extra-and intracellular volumes. Furthermore, ICPw monitoring can be a new parameter to consider when defining the moment to start substitutive therapy.

Prevalence of anxiety and depression and its comorbidities in patients with chronic kidney disease on hemodialysis and peritoneal dialysis.

INTRODUCTION: Patients with chronic kidney disease (CKD) who perform renal replacement therapy (RRT) are subject to a higher prevalence of mood disorders. OBJECTIVE: The aim of this study is to compare the prevalence of anxiety and depression in patients on hemodialysis (HD) and peritoneal dialysis (PD), taking into account comorbidities that may contribute to this. METHODS: The study was done in Ponta Grossa with CKD patients, using Beck Depression and Anxiety Inventory (BDI and BAI) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: We studied 155 patients, 128 in the HD group and 27 in PD. In the first, depression was found in 22.6% of patients in the BDI and 9.3% in HADS, and anxiety 25.7% in the BAI and 11.7% in the HADS. In the PD group, 29.6% of patients had depression in the BDI and 14.8% in HADS, and anxiety 11.1% in the BAI and none in HADS. CONCLUSION: The hemodialysis or peritoneal dialysis did not influence the prevalence of anxiety and depression in patients with CKD.

Implications of the use of vascular CDL in hemodialysis patients: analysis of echographic insertion sites.

INTRODUCTION: Chronic renal failure is a disease which prevalence has been increasing in Brazil. Hemodialysis is their primary therapeutic modality and arterio-venous fistula their preferential access. Nevertheless, many patients require the use of double-lumen catheters, either as permanent or temporary access. Vascular complications related to this procedure may occur, and their best method of non-invasive analysis is ultrasound analysis. OBJECTIVE: To analyze the complications by the use of double-lumen catheter in patients with chronic kidney disease on hemodialysis, at "Santa Casa de Misericordia de Ponta Grossa" hospital, through eco-Doppler exam. METHODS: Observational research, analytical, case-control type, to obtain data we used TASY®, interview, physical exam and imaging (eco-Doppler). RESULTS: None of the variables was significant isolated as a predictor of vascular impact in eco-Doppler, which detected changes in 31.25% of the cases. Physical exam showed poor accuracy compared to Doppler capacity to detect complications (K = -0.123). CONCLUSION: We conclude that the vascular effects of the use of CDL are frequent (31.25%). Manifesting itself in the form of occlusions with/without recanalization and stenoses. This leads us to required a prior analysis of the insertion site with Doppler, in order to avoid unnecessary procedures and possible complications.

Evaluation of the use of captopril on peritoneal fibrosis induced in rats by the use of glucose solution 4.25%.

INTRODUCTION: Chronic renal failure has alarming incidence all over the world in this century. Among the modalities of dialytic treatment, peritoneal dialysis has a major spot. This method of dialytic treatment may present complications, and among those is peritoneal fibrosis. It occurs in patients submitted to peritoneal dialysis along years. It's most dangerous form is sclerosing encapsulant peritonitis, wich leads to a need of change in modality and many times lead to death. OBJECTIVE: Study the influence of using captopril on the peritoneal fibrosis induced in rats using solution with glucoses 4.25%. METHODS: Prospective controlled study in 20 non-uremic Wistar rats. The animals received a peritoneal infusion of 10 ml/100g of peritoneal dialysis solution glucose 4.25% on a daily basis. The animals were divided in two groups: experimental and control. The experimental group received captopril 30 mg/kg/d, by a gastric tube. The control group did not receive any drug. The follow-up was 21 and 49 days. At the end, one surgical procedure was performed to get histological samples of visceral and parietal peritoneum. The samples were analyzed using Hematoxylin Eosin and Sirius Red, to evaluate the severity of the fibrosis. RESULTS: The analysis showed that the intensity of the fibrosis, the peritoneal thickness and the cell number in experimental and control groups were not statistically significant different in experimental and control groups. CONCLUSION: Our findings indicate that captopril do not decrease the intensity of fibrosis on the peritoneal membrane that happens on rats on peritoneal dialysis.

The influence of simvastatin in induced peritoneal fibrosis in rats by peritoneal dialysis solution with glucosis 4.25%.

PURPOSE: To investigate the influence of using simvastatin on the peritoneal fibrosis induced in rats using peritoneal dialysis solution with glucoses 4.25%. METHODS: Prospective controlled study in 20 non-uremic Wistar rats. The animals received a peritoneal infusion of 10 ml/100 g of peritoneal dialysis solution glucose 4.25% on a daily basis. The animals were divided in two groups: experimental and control. The experimental group received simvastatin 4 mg/kg/d, by a gastric tube. The control group did not receive any drug. The follow-up was 21 and 49 days. At the end, one surgical procedure was performed to get histological samples of visceral and parietal peritoneum. The samples were analyzed using Hematoxylin Eosin and Sirius Red, to evaluate the severity of the fibrosis. RESULTS: The analysis showed that the intensity of the fibrosis, the peritoneal thickness and the cell number in experimental and control groups were not statistically significant different in experimental and control groups. CONCLUSION: The simvastatin do not decrease the intensity of fibrosis on the peritoneal membrane that happens on rats on peritoneal dialysis.

Repercussões vasculares do uso de CDL em pacientes hemodialíticos: análise ecográfica dos sítios de inserção / Implications of the use of vascular CDL in hemodialysis patients: analysis of echographic insertion sites

Introdução: A doença renal crônica é uma doença cuja prevalência tem aumentado no Brasil. A hemodiálise é sua principal modalidade terapêutica e tem, como via de acesso preferencial, a confecção de fístula arteriovenosa. Apesar disso, muitos pacientes necessitam do uso de cateteres duplo-lúmen, seja como acesso temporário ou permanente. Complicações vasculares relacionadas a este procedimento podem ocorrer, sendo o melhor método de avaliação não invasiva a análise ecográfica. Objetivo: Analisar as complicações pelo uso do cateter duplo-lúmen em pacientes com doença renal crônica, em hemodiálise, no Hospital Santa Casa de Misericórdia de Ponta Grossa, PR, por meio do eco-Doppler. Métodos: Estudo observacional, analítico, tipo caso-controle, com obtenção dos dados por TASY®, questionário, exame físico direcionado e exame de imagem (eco-Doppler). Resultados: Nenhuma das variáveis analisadas se mostrou significativa isoladamente como preditora de repercussão vascular no eco-Doppler, que detectou alterações em 31,25% dos casos. O exame físico se mostrou de péssima acurácia em relação ao eco-Doppler na detecção das complicações (K = -0,123). Conclusão: Concluímos que as repercussões vasculares do uso de CDL são frequentes (31,25%), manifestando-se na forma de oclusões com/sem recanalização e estenoses. Sendo assim, é necessária uma análise prévia do sítio de inserção com o eco-Doppler, a fim de se evitar procedimentos desnecessários e com possíveis complicações. .

Introduction: Chronic renal failure is a disease which prevalence has been increasing in Brazil. Hemodialysis is their primary therapeutic modality and arterio-venous fistula their preferential access. Nevertheless, many patients require the use of double-lumen catheters, either as permanent or temporary access. Vascular complications related to this procedure may occur, and their best method of non-invasive analysis is ultrasound analysis. Objective: To analyze the complications by the use of double-lumen catheter in patients with chronic kidney disease on hemodialysis, at "Santa Casa de Misericordia de Ponta Grossa" hospital, through eco-Doppler exam. Methods: Observational research, analytical, case-control type, to obtain data we used TASY®, interview, physical exam and imaging (eco-Doppler). Results: None of the variables was significant isolated as a predictor of vascular impact in eco-Doppler, which detected changes in 31.25% of the cases. Physical exam showed poor accuracy compared to Doppler capacity to detect complications (K = -0.123). Conclusion: We conclude that the vascular effects of the use of CDL are frequent (31.25%). Manifesting itself in the form of occlusions with/without recanalization and stenoses. This leads us to required a prior analysis of the insertion site with Doppler, in order to avoid unnecessary procedures and possible complications. .

Prevalência de ansiedade e depressão e suas comorbidades em pacientes com doença renal crônica em hemodiálise e diálise peritoneal / Prevalence of anxiety and depression and its comorbidities in patients with chronic kidney disease on hemodialysis and peritoneal dialysis

Introdução: Os pacientes com doença renal crônica (DRC) que realizam terapia renal substitutiva (TRS) estão sujeitos a maior prevalência de distúrbios de humor. Objetivo: O objetivo do presente estudo é comparar a prevalência de ansiedade e depressão nos pacientes que realizam hemodiálise (HD) e diálise peritoneal (DP), levando em conta comorbidades que podem contribuir para isso. Métodos: O estudo foi realizado em Ponta Grossa, PR, com pacientes portadores de DRC, utilizando os inventários de depressão e ansiedade de Beck (BDI e BAI) e a Escala Hospitalar de Ansiedade e Depressão (EHAD). Resultados: Foram estudados 155 pacientes, 128 no grupo em HD e 27 em DP. No primeiro, depressão foi encontrada em 22,6% dos pacientes no BDI e em 9,3% na EHAD, e ansiedade em 25,7% no BAI e em 11,7% na EHAD. No grupo em DP, 29,6% dos pacientes apresentaram depressão no BDI e 14,8% na EHAD, e ansiedade em 11,1% no BAI e em nenhum na EHAD. Conclusão: A realização de hemodiálise ou diálise peritoneal não influenciou na prevalência de ansiedade ou depressão nos pacientes com DRC. .

Introduction: Patients with chronic kidney disease (CKD) who perform renal replacement therapy (RRT) are subject to a higher prevalence of mood disorders. Objective: The aim of this study is to compare the prevalence of anxiety and depression in patients on hemodialysis (HD) and peritoneal dialysis (PD), taking into account comorbidities that may contribute to this. Methods: The study was done in Ponta Grossa with CKD patients, using Beck Depression and Anxiety Inventory (BDI and BAI) and the Hospital Anxiety and Depression Scale (HADS). Results: We studied 155 patients, 128 in the HD group and 27 in PD. In the first, depression was found in 22.6% of patients in the BDI and 9.3% in HADS, and anxiety 25.7% in the BAI and 11.7% in the HADS. In the PD group, 29.6% of patients had depression in the BDI and 14.8% in HADS, and anxiety 11.1% in the BAI and none in HADS. Conclusion: The hemodialysis or peritoneal dialysis did not influence the prevalence of anxiety and depression in patients with CKD. .

Avaliação do uso do captopril na fibrose peritoneal induzida em ratos pelo uso de solução de glicose a 4,25% / Evaluation of the use of captopril on peritoneal fibrosis induced in rats by the use of glucose solution 4.25%

INTRODUÇÃO: A Insuficiência Renal Crônica (IRC) tem incidência alarmante neste século. A diálise peritoneal, uma das modalidades de terapia renal pode ter complicações, e entre estas a fibrose peritoneal, que ocorre com o decorrer dos anos nestes pacientes. Sua forma mais grave é a chamada peritonite esclerosante encapsulante, levando à mudança de terapia dialítica. OBJETIVO: Estudar a influência do uso do captopril na fibrose peritoneal induzida em ratos pelo uso de solução de glicose a 4,25 %. MÉTODOS: Estudo prospectivo controlado, em ratos Wistar não urêmicos. Foram estudados 20 animais. Os animais foram submetidos diariamente à punção abdominal, sendo infundida solução de diálise peritoneal com glicose a 4,25% na dose de 10 ml/100 g de peso. Os animais foram divididos em 2 grupos: experimental e controle. O grupo experimental recebeu captopril na dose de 30 mg/kg/dia por gavagem. O grupo controle não recebeu nenhuma droga. Foram acompanhados por 21 e 49 dias. Ao final do período foram submetidos à procedimento cirúrgico para retirada de peritônio parietal e visceral. As amostras obtidas foram analisadas histologicamente, usando-se coloração Hematoxilina - Eosina e Sirius Red, para avaliação do grau de fibrose. RESULTADOS: A análise mostrou que a intensidade da fibrose, a espessura do peritônio e o número de células não atingiram diferença estatisticamente significante entre os grupos experimental e controle. CONCLUSÃO: O estudo mostrou que o uso do captopril não foi capaz de alterar a intensidade da fibrose peritoneal induzida pelo uso de solução de diálise em ratos.

INTRODUCTION: Chronic renal failure has alarming incidence all over the world in this century. Among the modalities of dialytic treatment, peritoneal dialysis has a major spot. This method of dialytictreatment may present complications, and among those is peritoneal fibrosis. It occurs in patients submitted to peritoneal dialysis along years. It's most dangerous form is sclerosing encapsulant peritonitis, wich leads to a need of change in modality and many times lead to death. OBJECTIVE: Study the influence of using captopril on the peritoneal fibrosis induced in rats using solution with glucoses 4.25%. METHODS: Prospective controlled study in 20 non-uremic Wistar rats. The animals received a peritoneal infusion of 10 ml/100g of peritoneal dialysis solution glucose 4.25% on a daily basis. The animals were divided in two groups: experimental and control. The experimental group received captopril 30 mg/kg/d, by a gastric tube. The control group did not receive any drug. The follow-up was 21 and 49 days. At the end, one surgical procedure was performed to get histological samples of visceral and parietal peritoneum. The samples were analyzed using Hematoxylin Eosin and Sirius Red, to evaluate the severity of the fibrosis. RESULTS: The analysis showed that the intensity of the fibrosis, the peritoneal thickness and the cell number in experimental and control groups were not statistically significant different in experimental and control groups. CONCLUSION: Our findings indicate that captopril do not decrease the intensity of fibrosis on the peritoneal membrane that happens on rats on peritoneal dialysis.

The influence of simvastatin in induced peritoneal fibrosis in rats by peritoneal dialysis solution with glucosis 4.25% / Influência da sinvastatina na fibrose peritoneal induzida em ratos pelo uso de solução de diálise peritoneal com glicose a 4,25%

PURPOSE: To investigate the influence of using simvastatin on the peritoneal fibrosis induced in rats using peritoneal dialysis solution with glucoses 4.25%. METHODS: Prospective controlled study in 20 non-uremic Wistar rats. The animals received a peritoneal infusion of 10 ml/100 g of peritoneal dialysis solution glucose 4.25% on a daily basis. The animals were divided in two groups: experimental and control. The experimental group received simvastatin 4 mg/kg/d, by a gastric tube. The control group did not receive any drug. The follow-up was 21 and 49 days. At the end, one surgical procedure was performed to get histological samples of visceral and parietal peritoneum. The samples were analyzed using Hematoxylin Eosin and Sirius Red, to evaluate the severity of the fibrosis. RESULTS: The analysis showed that the intensity of the fibrosis, the peritoneal thickness and the cell number in experimental and control groups were not statistically significant different in experimental and control groups. CONCLUSION: The simvastatin do not decrease the intensity of fibrosis on the peritoneal membrane that happens on rats on peritoneal dialysis.

OBJETIVO: Investigar a influência do uso da sinvastatina na fibrose peritoneal induzida em ratos pelo uso de solução de diálise peritoneal rica em glicose. MÉTODOS: Estudo prospectivo controlado, em ratos Wistar não urêmicos. Foram estudados 20 animais. Os animais foram submetidos diariamente à punção abdominal, sendo infundida solução de diálise peritoneal com glicose a 4,25% na dose de 10 ml/100 g de peso. Os animais foram divididos em dois grupos: experimental e controle. O grupo experimental recebeu sinvastatina na dose de 4 mg/kg/dia por gavagem. O grupo controle não recebeu nenhuma droga. Foram acompanhados por 21 e 49 dias. Ao final do período foram submetidos à procedimento cirúrgico para retirada de peritônio parietal e visceral. As amostras obtidas foram analisadas histologicamente, usando-se coloração Hematoxilina - Eosina e Sirius Red, para avaliação do grau de fibrose. RESULTADOS: A análise mostrou que a intensidade da fibrose, a espessura do peritônio e o número de células não atingiram diferença estatisticamente significante entre os grupos experimental e controle. CONCLUSÃO: A sinvastatina não foi capaz de alterar a intensidade da fibrose peritoneal induzida pelo uso de solução de diálise em ratos.

Potássio intra-eritrocitário e diureticoterapia / Intraerythrocytic potassium and diuretic therapy

A hipocalemia induzida por diurético é um dops distúrbios mais comuns e importantes durante a terpapêutica anti-hipertensiva. No entanto, tem sido sugerido que mediçöes dos níveis de potássio sérico possam näo refletir alteraçöes significativas da concentraçäo intracelular. Este estudo foi realizado para avaliar alteraçöes na concentraçäo de potássio das hemácias, comparada aos níveis séricos de potássio, em 10 pacientes que receberam clortalidona, 25 mg/dia, durante 4 semanas. As respostas anti-hipertensivas alcançadas foram significativas e, apesar dos níveis séricos de potássio em quatro pacientes, terem ficado abaixo de 3,5 mEq/1, näo ocorreram alteraçöes na concentraçäo intracelular de potássio nesta populaçäo com hipertensäo essencial

Efeitos anti-hipertensivos, e bioquímicos: hidroclorotiazida, furosemide de açäo prolongada e combinaçäo amiloride/hidroclorotiazida no tratamento de hipertensäo arterial / Antihypertensive and biochemical effects: hydrochlorothiazide, prolonged action furosemide amiloride/hydrochlorothiazide combination in the treatment of arterial hypertension

O presente estudo avalia os efeitos anti-hipertensivos e as modificaçöes na bioquímica sérica induzidas por 3 diferentes diuréticos - hidroclorotiazida, furosemide de açäo prolongada e combinaçäo amiloride/hidroclorotiazida - usados em seqüência em indivíduos com hipertensäo arterial essencial. Genericamente, confirmaram-se os efeitos anti-hipertensivos das 3 drogas, ainda que hidroclorotiazida, isoladamente ou em combinaçäo com amiloride, tivesse tido efeito mais consistentes. Similarmente a estudos anteriores, furosemide näo modificou os parâmetros usuais de bioquímica sérica, e amiloride preveniu a hipocalemia habitualmente encontrada com hidroclorotiazida