Calidad de vida percibida y adherencia al tratamiento en pacientes con insuficiencia renal crónica terminal / Perceived quality of life and adherence to treatment in patients with end-stage chronic renal disease / Qualidade de vida percebida e adesão ao tratamento em pacientes com doença renal crônica em estágio terminal

RESUMEN Introducción: La insuficiencia renal crónica terminal constituye uno de los problemas de salud más complejos por las afectaciones que provoca a la calidad de vida de los pacientes y por las dificultades que entraña la adherencia del paciente al tratamiento. Objetivo: Identificar la relación entre la calidad de vida percibida y la adherencia al tratamiento de los pacientes portadores de insuficiencia renal crónica terminal que reciben hemodiálisis. Método: Estudio de tipo correlacional realizado en el servicio de Hemodiálisis del Hospital General Docente "Juan B. Viñas González" de Palma Soriano, Santiago de Cuba. Del universo de 32 pacientes se trabajó con la población constituida por 16 pacientes que cumplieron con los criterios de inclusión/exclusión. Las técnicas utilizadas fueron: cuestionario de calidad de vida de la OMS, revisión de documentos, entrevistas y la observación. Se realizó análisis estadístico descriptivo (análisis de frecuencias) y se aplicó el método no paramétrico de correlación de Spearman. Resultados: Más de la mitad (56,25 %) de la población reflejó una calidad de vida percibida regular, el 25 % buena y el 18,75 % mala. La dimensión de salud física se mostró dentro de las más afectadas, observándose una valoración negativa con respecto a la enfermedad, pues más del 85 % de los encuestados la consideró como grave o muy grave. Se apreciaron afectaciones al sueño, donde más del 60 % de los pacientes se sintió insatisfecho con este aspecto. Los síntomas de la enfermedad son valorados, por la mayoría (81,25 %) como severos o muy severos. Conclusiones: Los pacientes poseen adherencia media al tratamiento y una calidad de vida percibida regular, y existe correlación fuerte y directa entre la adherencia al tratamiento y la calidad de vida percibida.

ABSTRACT Introduction: The end-stage chronic renal disease, due to how it affects the patient´s quality of life and the difficulties involved in the adherence of patient to treatment, is one of the most complex health problems. Objective: To identify the relationship between perceived quality of life and adherence to treatment in patients with end-stage chronic renal disease receiving hemodialysis. Method: A correlative study was conducted in the hemodialysis service room at the Hospital General Docente "Juan B. Viñas González" in Palma Soriano, Santiago de Cuba. The universe studied included 32 patients and 16 (met inclusion/exclusion criteria) were selected to work with. The techniques used were: World Health Organization quality of life questionnaire, document review, interviews and observation. A descriptive statistical analysis was performed (frequency analysis) and the nonparametric method applied was the Spearman's correlation coefficient using the SPSS 19.0 data processing program. Results: More than half of the population (56.25%) reported a fair quality of life, good (25%), and bad (18.75%). The physical health dimension was one of the most affected and it was found a negative assess of the disease in which more than 85% of those polled considered it as serious or very serious. Some sleep disorders was found and more than 60% of patients were unsatisfied related this issue. Most of the patients (81.25%) characterized the disease symptoms as severe or very severe. Conclusions: Patients studied had an adherence to treatment in a medium level and a perceived fair quality of life. There is also a correlation between the patient adherences to treatment and perceived quality of life.

RESUMO Introdução: A insuficiência renal crônica terminal constitui um dos problemas de saúde mais complexos pelos efeitos que causa na qualidade de vida dos pacientes e pelas dificuldades que a adesão do paciente ao tratamento acarreta. Objetivo: Identificar a relação entre a percepção de qualidade de vida e a adesão ao tratamento em pacientes com doença renal terminal em hemodiálise. Método: Estudo do tipo correlacional realizado no serviço de Hemodiálise do Hospital Geral de Ensino "Juan B. Viñas González" em Palma Soriano, Santiago de Cuba. Do universo de 32 pacientes, trabalhamos com a população composta por 16 pacientes que atenderam aos critérios de inclusão / exclusão. As técnicas utilizadas foram: questionário de qualidade de vida da Organização Mundial da Saúde, revisão documental, entrevistas e observação. Foi realizada análise estatística descritiva (análise de frequência) e aplicado o método não paramétrico. Resultados: Mais da metade (56,25%) da população apresentou percepção de qualidade de vida regular, 25% boa e 18,75% ruim. A dimensão saúde física esteve entre as mais afetadas, com avaliação negativa em relação à doença, uma vez que mais de 85% dos inquiridos a consideraram grave ou muito grave. Além disso, foram notados distúrbios do sono, onde mais de 60% dos pacientes se sentiram insatisfeitos com esse aspecto. Os sintomas da doença são avaliados, pela maioria (81,25%), como graves ou muito graves. Conclusões: Os pacientes apresentam média de adesão ao tratamento e percepção de qualidade de vida regular, havendo forte e direta correlação entre adesão ao tratamento e percepção de qualidade de vida.

Advance in Evaluation Formula of Glomerular Filtration Rate in Patients with Spinal Cord Injury (review) / 中国康复理论与实践

Patients with spinal cord injury are in high risk of chronic kidney disease (CKD). Glomerular filtration rate (GFR) is an important indicator commonly used to detect CKD. This paper reviewed the pros and cons of existing endogenous and exogenous GFR measurement, and focused on the problems and challenges for the application of the estimating glomerular filtration rate (eGFR) in patients with spinal cord injury. These research results indicated that the applicability of traditional eGFR to patients with spinal cord injury is still insufficient. It is necessary to modify eGFR in clinical research and application in spinal cord injury.

Associação entre força de preensão manual e indicadores nutricionais em pacientes em tratamento hemodialítico / Association between handgrip strength and nutritional indicators in patients undergoing hemodialysis

Objetivo: Verificar a associação entre a força de preensão manual (FPM) e indicadores nutricionais em pacientes em tratamento hemodialítico do Oeste da Bahia. Métodos: Trata-se de um estudo transversal, realizado com pacientes adultos e idosos, cadastrados em uma unidade de hemodiálise do Oeste da Bahia. Foi aplicado questionário estruturado com questões referentes às condições sociodemográficas e realizada análise das variáveis antropométricas, de composição corporal, clínicas e bioquímicas. A FPM foi medida do lado não fistuloso com um dinamômetro hidráulico da marca SAEHAN® (Saehan corporation ­ SH5001). A análise dos dados foi realizada com o auxílio do software Stata 13.1. Resultados: Foram avaliados 113 pacientes, com predominância do sexo masculino (60,55%) e faixa etária de 35 a 59 anos (57,52%). Foram encontradas associações positivas entre a altura e a FPM, sendo que quanto maior a altura, maior é a força (p = 0,020). O maior peso corporal após sessão de hemodiálise também se apresentou associado à maior FPM (p = 0,002). A medida da prega cutânea tricipital mostrou associação inversa (p = 0,007) e o ângulo de fase foi positivamente associado à FPM (p = 0,018). Conclusão: A força de preensão manual foi associada positivamente a altura, peso corporal após sessão de hemodiálise e ângulo de fase. Em contrapartida, a FPM associou-se negativamente à prega cutânea tricipital. (AU)

Objective: To assess the association between handgrip strength (HGS) and nutritional indicators in patients undergoing hemodialysis in western Bahia State, Brazil. Methods: This is a cross-sectional study conducted with adult and elderly patients attending a hemodialysis unit in western Bahia. A structured questionnaire containing sociodemographic questions was administered, and anthropometric, body composition, clinical, and biochemical variables were analyzed. HGS was measured on the non-fistula side using a Saehan® hydraulic dynamometer. Data analysis was performed using Stata version 13.1. Results: A total of 113 patients were evaluated, most of whom were male (60.55%) and aged between 35 and 59 years (57.52%). Positive associations were found between height and HGS; the higher the patient height, the higher the HGS (p = 0.020). Higher post-dialysis body weight was also associated with higher HGS (p = 0.002). Triceps skinfold thickness was inversely associated (p = 0.007) with HGS, whereas phase angle showed a positive association (p = 0.018). Conclusion: HGS was positively associated with height, post-dialysis body weight, and phase angle but negatively associated with triceps skinfold thickness. (AU)

Estado Nutricional e Indicadores de Estrés Oxidativo entre pacientes con enfermedad renal en etapa terminal. Tratado ambulatorio continuo con dialisis Peritoneal / Nutritional Status and Indicators of Oxidative Stress among End-Stage Renal Disease Patients Treated with Continuous Ambulatory Peritoneal Dialysis

Background: The objective of the study was to determine the oxidative stress (OS) intensity depending on the nutritional status (NS) among end-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD) and to investigate the effectiveness of medical strategies for the correction of nutritional disorders (ND). Methods: 69 end-stage renal disease patients treated with CAPD were examined who had varying degrees of ND. General clinical, biochemical parameters, OS markers were identified. Basing on the obtained data, the level of OS markers was determined in groups of patients with different NS. Subsequently, patients with moderate and severe ND were randomly assigned to two groups. The first group (n=20) included patients who received in complex treatment additionally to traditional treatment of CAPD Levocarnitine and one exchange per day of intraperitoneal fluid with amino acids. The second group consisted of patients (n=20) who received instead of one Dianeal fluid intraperitoneal fluid with amino acids. Results: OS indicators were increased in all four groups of patients with different NS, but they were the highest among patients with moderate and severe malnutrition. After the treatment the patients of the first study group had a statistically significant decrease in the MDA content, both in blood serum and erythrocytes (p<0.005). At the same time, the analysis of the informative markers dynamics for antioxidant oxidative stress (AOS) of blood serum allowed to register a statistically credible increase in their mean values among patients after treatment (p<0.05). It should be emphasized that no statistically significant effect of Levocarnitine on the anthropometric parameters of nutritional status and serum albumin level was obtained. However, after the therapy in the study group the values of SGA and protein consumption with food increased (p<0.05). At the same time, the patients from second study group had no positive effect on the reduction of oxidative stress, except for the level of transferrin (p<0.05) and contributes to the increase of serum albumin level (p<0.05).

Hyperkalemia in chronic kidney disease

SUMMARY Hyperkalemia is a frequent finding in patients with chronic kidney disease (CKD). This increase in serum potassium levels is associated with decreased renal ion excretion, as well as the use of medications to reduce the progression of CKD or to control associated diseases such as diabetes mellitus and heart failure. Hyperkalemia increases the risk of cardiac arrhythmia episodes and sudden death. Thus, the control of potassium elevation is essential for reducing the mortality rate in this population. Initially, the management of hyperkalemia includes orientation of low potassium diets and monitoring of patients' adherence to this procedure. It is also important to know the medications in use and the presence of comorbidities to guide dose reduction or even temporary withdrawal of any of the potassium retention-related drugs. And finally, the use of potassium binders is indicated in both acute episodes and chronic hyperkalemia.

RESUMO A hiperpotassemia é um achado frequente em pacientes com doença renal crônica (DRC). Esta elevação do nível sérico de potássio está associada à diminuição da excreção renal do íon, assim como ao uso de medicações para retardar a progressão da DRC ou para controlar doenças associadas, como diabetes mellitus e insuficiência cardíaca. A hiperpotassemia aumenta o risco de episódios de arritmia cardíaca e morte súbita. Assim, o controle da elevação de potássio é essencial para a diminuição da taxa de mortalidade nessa população. O manejo da hiperpotassemia inclui, inicialmente, orientação de dietas com baixo teor de potássio e acompanhamento da aderência dos pacientes a esse procedimento. Também é importante conhecer as medicações em uso e a presença de comorbidades, a fim de orientar a redução de doses ou até mesmo a suspensão temporária de alguma das drogas relacionadas à retenção de potássio. E, finalmente, o uso de quelantes de potássio é indicado tanto em episódios agudos como nos casos de hiperpotassemia crônica.

Meta-analysis of the Efficacy and Safety of Prophylactic Use of Low-dose Aspirin in Patients with Chronic Renal Disease / 中国药房

OBJECTIVE：To evaluate the efficacy and safety of prophylactic use of low-dose aspirin in patients with chronic renal disease ，and to provide reference for evidence-based reference for rational use in the clinic. METHODS ：Retrieved from PubMed，Embase，Cochrane Library ，CNKI，VIP，Wanfang database ，RCTs about prophylactic use aspirin 75-150 mg/d（aspirin group）versus no aspirin and other antiplatelet drugs or placebo （control group ）were collected from inception to May 14th，2019. Relevant data were extracted. After quality evaluation with bias risk assessment tool recommended by Cochrane system evaluator manual 5.1.0，Meta-analysis of the incidence of cardiovascular events ，renal events and bleeding events in patients with chronic renal disease was performed by using Rev Man 5.3 software. RESULTS ：A total of 5 RCTs were included ，involving 4 728 patients；among them ，there were 2 392 persons in aspirin group and 2 390 persons in control group. Results of Meta-analysis showed that there was no statistical significance in the incidence of cardiovascular events [OR ＝0.59，95％CI（0.13，1.12），P＝0.11] and the incidence of renal events [OR ＝0.42，95％CI（0.08，2.23），P＝0.31] between aspirin group and control group. The incidence of bleeding events [OR ＝2.12，95％CI（1.23，3.66），P＝0.007] in aspirin group was significantly higher than control group. After exculsion of two heterogeneity literatures ，the incidence of cardiovascular events [OR ＝0.27，95％CI（0.13，0.55），P＝0.000 3] in aspirin group was significantly lower than control group. CONCLUSIONS ：Prophylactic use of low-dose aspirin can prevent cardiovascular events in patients with chronic renal disease to certain extent. The low-dose aspirin should be used carefully to prevent cardiovascular events in chronic renal disease patients with high risk of bleeding.

Autoavaliação da saúde de indivíduos com doença renal crônica em terapia dialítica / Health self-assessment by individuals with chronic kidney disease in dialysis therapy / Autoevaluación de la salud de individuos con enfermedad renal crónica en terapia dialítica

Objetivo: analisar a autopercepção de saúde e os fatores associados dos indivíduos com doença renal crônica em terapia dialítica. Método: estudo transversal, quantitativo, com 42 pacientes assistidos na unidade de nefrologia de um hospital público em Recife/PE, no período de maio a agosto de 2016. Os dados foram coletados por meio de entrevista semiestruturada, analisados por estatística descritiva e inferencial, após aprovação do Comitê de Ética em Pesquisa. Resultados: a autoavaliação de saúde ruim esteve presente em 29 (69%) pacientes, porém sem associação com as características sociodemográficas e clínicas (p<0,05). Conclusão: a alta prevalência da autoavaliação de saúde ruim reflete a necessidade de informações educativas e autocuidado para uma melhor compreensão do estado de saúde e consequente adesão terapêutica.

Objective: to examine health self-perception and associated factors in individuals with chronic kidney disease in dialysis therapy. Method: in this quantitative, cross-sectional study of 42 patients attending the nephrology unit of a public hospital in Recife, Pernambuco, from May to August 2016, data were collected by semistructured interview and analyzed by descriptive and inferential statistics, after approval by the research ethics committee. Results: 29 patients (69%) self-assessed their health as poor, but no association was found with sociodemographic and clinical characteristics (p<0.05). Conclusion: the high prevalence of self-assessed poor health reflects the need for educational information and self-care for a better understanding of health status and consequent adherence to therapy.

Objetivo: analizar la autopercepción de salud y los factores asociados de los individuos con enfermedad renal crónica en terapia dialítica. Método: estudio transversal, cuantitativo, junto a 42 pacientes asistidos en la unidad de nefrología de un hospital público en Recife/Pernambuco, en el período de mayo a agosto de 2016. Los datos fueron recolectados por medio de entrevista semiestructurada, analizados por estadística descriptiva e inferencial, después de la aprobación del Comité de Ética en Investigación.Resultados: la autoevaluación de mala salud estuvo presente en 29 (69%) pacientes, pero sin asociación con las características sociodemográficas y clínicas (p <0,05). Conclusión: la alta prevalencia de la autoevaluación de mala salud refleja la necesidad de informaciones educativas y autocuidado para una mejor comprensión del estado de salud y consecuente adhesión terapéutica

Estimación de la tasa de filtración glomerular en adultos mayores mediante las ecuaciones CKD-EPI / Estimate of the glomerular filtration rate in aged adults through the CKD-EPI equations

Introducción: La tasa de filtración glomerular se considera el mejor índice para evaluar la función renal, ya que su reducción aparece mucho antes que cualquier manifestación clínica derivada de la disfunción renal. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 92 pacientes sin enfermedad renal y con esta, atendidos en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de febrero a noviembre de 2017, a fin de evaluar las ecuaciones insuficiencia renal crónica-colaboración epidemiológica (CKD-EPI) para estimar el filtrado glomerular en adultos mayores. Resultados: Se halló menor promedio de filtrado con orina de 24 horas en el grupo sin nefropatía (64,8 mL/min) y mayor en el grupo de nefrópatas (25,8 mL/min) respecto a dichas ecuaciones. Aunque no hubo diferencias significativas en el filtrado según edad, sexo y peso corporal, en ambos grupos al emplear CKD-EPI, los valores mayores se obtuvieron con CKD-EPI cistatina C. Conclusiones: En los ancianos sin marcadores de daño renal la utilización de las fórmulas CKD-EPI con cistatina permite una mejor estimación de la función renal.

Introduction: The glomerular filtration rate is considered the best index to evaluate the renal function, since its reduction is evidenced much time before any clinical manifestation which derives from the renal failure. Methods: A descriptive, cross-sectional and observational study of 92 patients without and with renal disease, assisted in Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from February to November, 2017, was carried out in order to estimate glomerular filtrate in older adults by means of the CKD-EPI equations. Results: Lower average filtrate with 24 hours urine was found in the group without nefropathy (64.8 mL/min) and it was higher in the kidney disease group (25.8 mL/min) regarding these equations. Although in both groups there were no significant differences in the filtrate according to age, sex and corporal weight, when using the equations CKD-EPI, the higher values were obtained with CKD-EPI cystatine C. Conclusions: The use of the formulas CKD-EPI with cystatine allows a better estimate of the renal function in aged patients without markers of renal damage.

Asociación entre Preeclampsia y Enfermedad Renal Crónica / Association between Preeclampsia and Chronic Kidney Disease

RESUMEN Introducción: La prevalencia de preeclampsia es 2 a 8%, escenario que puede suponer el inicio de alteraciones vasculares y metabólicas futuras, entre ellas, enfermedad renal crónica. Objetivo: Determinar la preeclampsia como factor asociado a enfermedad renal crónica. Material y métodos: Estudio de casos y control en mujeres con antecedente de embarazo. El tamaño de muestra fue de 60 casos y 40 controles. El grupo de casos lo integraron pacientes con enfermedad renal crónica (tasa de filtrado glomerular menor a 60 ml/min/1.73m2, fórmula CKD-EPI), el grupo de control conformado por pacientes sin enfermedad renal crónica. El diagnóstico de preeclampsia se determinó por el antecedente médico. El análisis estadístico incluyó prueba de Chi-cuadrado (X2), razón de momios, regresión logística y cálculo de probabilidad de ocurrencia del evento. Resultados: En pacientes con enfermedad renal crónica el 80% refiere antecedente de preeclampsia, y en pacientes sin enfermedad renal crónica el 35% también tiene este antecedente (p=0.00). El tiempo de evolución entre el antecedente de preeclampsia y el diagnóstico de enfermedad renal crónica es 7.50 años (IC 95%; 7.10-7.89). El modelo que mejor explica la enfermedad renal crónica incluye la preeclampsia y la edad del paciente (p=0.000), y = -3.444 + 1.794 (antecedente de preeclampsia) + 0.082 (edad del paciente). Si existe antecedente de preeclampsia y la edad del paciente es 35 años, la probabilidad de enfermedad renal crónica es 0.7721. Conclusión: La preeclampsia es un factor asociado a enfermedad renal crónica.

ABSTRACT Introduction: With a prevalence of 2-8%, preeclampsia constitutes a scenario that may imply the beginning of future vascular and metabolic alterations, among which we could mention chronic kidney disease. Objective: To establish preeclampsia as a factor associated with chronic kidney disease. Methods: Case-control study covering women who had been pregnant. The population sample included 60 subjects in the case group and 40 in the control group. The case group included patients with chronic kidney disease (glomerular filtration rate lower than 60 ml/min/1.73m2, CKD-EPI formula); the control group included patients who did not suffer from chronic kidney disease. Preeclampsia diagnosis was established according to medical history. The statistical analysis comprised the chi-squared test (X2), odds ratio, logistic regression and event occurrence probability. Results: Among the chronic kidney disease patients, 80% reported a history of preeclampsia; 35% of subjects who did not suffer from chronic kidney disease also had a similar history (p=0.00). The time of evolution between preeclampsia and the diagnosis of chronic kidney disease was 7.5 years (95% CI: 7.10-7.89). The model which best explains chronic kidney disease includes preeclampsia and patient's age (p=0.000), y=-3.444 + 1.794 (history of preeclampsia) + 0.082 (patient's age). If the patient is 35 years old and has a history of preeclampsia, the probability of chronic kidney disease is 0.7721. Conclusion: Preeclampsia is a factor associated with chronic kidney disease.

Utilidad de la cistatina C como biomarcador precoz de daño renal en pacientes con diabetes mellitus de tipo 2 / Use of Cystatin C as early biomarker of renal damage in patients with diabetes mellitus type 2

Se llevó a cabo un estudio observacional, descriptivo, de serie de casos, en 144 pacientes con diabetes mellitus de tipo 2, atendidos en el Laboratorio Clínico del Hospital Provincial Clinicoquirúrgico Docente Saturnino Lora Torres de Santiago de Cuba, de mayo de 2017 a igual de 2018, procedentes de la consulta de Endocrinología del propio hospital, con vistas a evaluar la utilidad de la cistatina C como biomarcador precoz de daño renal. En la investigación predominaron los pacientes de más de 50 años de edad y del sexo femenino, además de la hipertensión arterial como enfermedad asociada y la neuropatía periférica como complicación. Se concluyó que la cistatina C es útil como biomarcador precoz de daño renal en pacientes con diabetes mellitus de tipo 2, fundamentalmente si existen comorbilidades y complicaciones que pudieran conducir a la enfermedad renal crónica, lo que puede prevenirse.

An observational, descriptive series of cases study, was carried out in 144 patients with diabetes mellitus type 2, assisted in the Clinical Laboratory of Saturnino Lora Torres Teaching Provincial Hospital in Santiago de Cuba from May, 2017 to the same month of 2018, who were from the Endocrinology Service of the same hospital, with the aim of evaluating the utility of the Cystatin C as early biomarker of renal damage. Patients older than 50 years of age and female sex, besides hypertension as associated disease and the outlying neuropathy as complication prevailed in the investigation. It was concluded that Cystatin C is useful as early biomarker of renal damage in patients with diabetes mellitus type 2, fundamentally if there are comorbidities and complications that could cause chronic renal failure, which can be prevented.

Envolvimento da pessoa com doença renal crônica em seus cuidados: revisão integrativa / Engaging people with chronic kidney disease in their own care an integrative review

Resumo A doença renal crônica (DRC) acarreta ao indivíduo uma sobrecarga de cuidados indispensáveis ao alcance das metas terapêuticas e qualidade de vida. O controle nutricional, o regime medicamentoso e as terapias de substituição renal são exemplos que requerem participação ativa. Assim, foi realizada revisão integrativa de artigos científicos para identificar os que versam sobre envolvimento e participação do paciente em seus cuidados na DRC. Os descritores "Chronic kidney disease"; "Self-Care" and "Patient Participation" foram aplicados nas bases CINHAL, Bireme e Medline. Selecionamos 21 publicações entre 2012 e 2016. A entrevista semiestruturada destacou-se como método de coleta de dados, com a aplicação da análise temática fenomenológica. Conforme a predominância do assunto tratado, os manuscritos foram alocados em quatro eixos temáticos: Manejo da doença renal e seu tratamento; Envolvimento na tomada de decisão; Plano avançado de cuidados; e, Diálise peritoneal domiciliar. Verificamos que abordagens envolvendo pessoas transplantadas ou nos primeiros estágios da doença são pouco explorados com a aplicação do método qualitativo e, ainda, consideramos que pessoas com DRC devem ser instigadas no envolvimento ativo de seus próprios cuidados, necessitando de conhecimento, motivação e suporte dos profissionais de saúde.

Abstract The treatment of chronic kidney disease (CKD) places a major burden on patients and their families. Interventions such as nutritional management, medication regimen, and renal replacement therapies require active patient participation. An integrative literature review was carried out to identify articles on the engagement and participation of people with CKD in their care. The Medical Subject Headings (MeSH) "Kidney Failure, Chronic", "Self Care", and "Patient Participation" were used to conduct a search on the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), the U.S. National Library of Medicine® (Medline/PubMed), Biblioteca Virtual em Saúde (Bireme). A total of 21 articles published between 2012 and 2016 were selected. The most commonly used data collection and analysis techniques were semi-structured interviews and phenomenological thematic analysis, respectively. The articles were categorized into the following thematic groups: illness management and treatment; involvement in the decision-making process; advanced care plan; and home peritoneal dialysis. We found that there is a lack of qualitative research in certain areas, namely kidney transplant recipients and people with initial stages of CKD. People with CKD should be encouraged to actively engage in their own care, which in turn requires the knowledge, motivation and support of health professionals.

Relationship between serum neutrophil gelatinase-associated apolipoprotein and cardiovascular events in patients with chronic renal disease / 中华内分泌外科杂志

Objective To investigate the relationship between (serum neutrophil gelatinase-associated lipocalin,sNGAL) and cardiovascular events in patients with chronic kidney disease(CKD).Methods 300 patients with CKD were divided into two groups according to the level of sNGAL:high sNGAL group (n=158) and low sNGAL group (n=142).The incidence of cardiovascular events and cumulative survival rate were analyzed by ROC curve,and the correlation between sNGAL and cardiovascular risk factors,cardiovascular events in patients with chronic renal disease was analyzed.Influencing factors of cardiovascular events in CKD patients was analyzed.Results There were significant differences in the data about BMI,diabetes proportion,CKD staging,eGFR,hsCRP,24h proteinuria,HDL,iPTH,phosphate and blood calcium between the two groups (P＜0.05).The 3-year cumulative survival rate of high sNGAL group(77.2％) was significantly lower than that of low sNGAL group(96.5％),and the 3-year incidence of cardiovascular events (37.9％) was significantly higher than that of low sNGAL group (9.8％) (P＜ 0.05).AUC in diagnosing cardiovascular events in high sNGAL group (0.746) was significantly higher than that in eGFR(0.636),age (0.504),serum calcium (0.545),HDL(0.594) and LDL (0.508,all P＜0.05).There was a significant correlation between sNGAL and eGFR,HDL,BMI,hs-CRP,iPTH and phosphate (P＜ 0.05).Both univariate and multivariate fact ors COX showed that sNGAL was a risk factor of cardiovascular events in patients with CKD (P＜0.05),((HR=1.976 and 1.588,95％ CI=1.443-2.724 and 1.144-2.143,respectively,P=0.O00 and 0.000)).Conclusions The incidence of cardiovascular events in patients with CKD with high sNGAL is significantly increased.sNGAL is an independent factor of cardiovascular events in patients with chronic renal disease.

Función renal en pacientes ambulatorios con insuficiencia cardíaca con fracción de eyección reducida; análisis de su evolución e implicancia pronóstica. Seguimiento a 4 años en una Unidad Multidisciplinaria de Insuficiencia Cardíaca / Renal function in outpatients with heart failure with reduced ejection fraction; analysis of its evolution and forecast implications. A 4 year follow up in a Multidisciplinary Unit of Heart Failure / Função renal em pacientes ambulatoriais com insuficiência cardíaca com fração de ejeção reduzida; análise de sua evolução e implicações prognósticas. Acompanhamento de até 4 anos em uma Unidade Multidisciplinar de Insuficiência Cardíaca

Resumen: Introducción: El deterioro de la función renal está asociado a un aumento de la mortalidad en los pacientes con insuficiencia cardíaca (IC). El objetivo de este estudio fue evaluar si la progresión de la enfermedad renal en pacientes estables portadores de IC con fracción de eyección reducida (ICFEr) y enfermedad renal crónica (ERC) se asocia a eventos cardiovasculares (ECV), hospitalización por IC y muerte. Metodología: Estudio de cohorte de seguimiento a 4 años, con análisis en dos etapas: tiempo 1 (inicio del estudio); y tiempo 2 (fin del estudio o muerte). Se definió ICFEr estable como IC con una fracción de eyección del ventrículo izquierdo (FEVI)<40% sin elementos de descompensación. Se definió ERC con la presencia de un filtrado glomerular estimado (FGe) < 60 ml/min/1,73 y ERC estable en ausencia de fracaso renal agudo. Resultados: Se incluyeron 94 pacientes con media de seguimiento de 37,2 meses; la edad media fue 69,5 años, 71.3% de sexo masculino. La cardiomiopatía era isquémica en 48% y la nefropatía vascular fue la predominante (62%). Se diagnosticó síndrome cardio-renal tipo 2 en 76 (81%) pacientes. Se evidenció descenso significativo del FGe entre los tiempos de análisis (tiempo 1: 45 ± 10 ml/min.; tiempo 2: 38 ± 15 ml/min.; p < 0,001) y 50% de los pacientes tuvieron peoría del estadio de ERC (p = 0,027). Se halló asociación entre progresión de la ERC con mayor frecuencia de ECV (P=0,002), ingresos por IC (OR 3,3;IC95% 1,9-11,2; p = 0.044) y muerte cardiovascular (OR 10,9;IC95% 2,9-40,1; p < 0.001). Conclusiones: La progresión de la ERC en pacientes con ICFEr ambulatorios se asocia a un peor pronóstico en términos de mortalidad cardiovascular, ingresos por IC y ECV.

Abstract: Introduction: Deterioration of renal function is associated with increased mortality in patients with heart failure (HF). The objective of the present study was to assess whether the progression of kidney disease is associated with the appearance of cardiovascular events (CVE), hospitalization for HF and death in a cohort of stable outpatients with chronic kidney disease (CKD) and Heart failure with reduced ejection fraction (HFrEF). Methodology: A 4 years follow-up cohort study, with a two stage analysis: time 1 (start of the study); and time 2 (end of study or death). Stable HFrEF was defined as HF with an ejection fraction of the left ventricle (LVEF)<40% without elements of decompensation. An estimated glomerular filtration less than 60 ml / min / 1.73 was used as diagnostic criterion for CKD and stable CKD in the absence of acute renal failure. Results: A total of 94 patients were included with a follow up mean of 37.2 months; the mean age was 69.5 years ± 9 years, 71.3% were male. Cardiomyopathy was ischemic in 48% and vascular nephropathy was predominant (62%). Cardio-renal syndrome type 2 was diagnosed in 76 (81%) patients. There was a significant decrease in eGFR between the time of analysis (time 1: 45 ± 10 ml/min, time 2: 38 ± 15 ml/min, p <0.001) and 50% of patients worsened their stage of CKD (p = 0.027). An association was found between progression of CKD with a higher frequency of CVD (P = 0.002), hospitalization for HF (OR 3.3, 95% CI 1.9-11.2, p = 0.044) and cardiovascular death (OR 10.9, 95% CI 2.9-40.1, p <0.001). Conclusions: The progression of CKD is associated with a worse prognosis in not hospitalized HF patients in terms of cardiovascular mortality, admissions for HF and CVE.

Resumo: Introdução: A deterioração da função renal está associada ao aumento da mortalidade em pacientes com insuficiência cardíaca (IC). O objectivo deste estudo foi avaliar se a progressão da doença renal em pacientes com IC estáveis ​​com fracção de ejecção reduzida (ICFER) e doença renal crónica (IRC) está associada com eventos cardiovasculares (DCV), HF hospitalização e morte. Metodologia: Estudo de coorte de acompanhamento aos 4 anos, com análise em duas etapas: tempo 1 (início do estudo); e tempo 2 (fim do estudo ou morte). O rEFFE estável foi definido como IC com fração de ejeção do ventrículo esquerdo (FEVE) <40% sem elementos de descompensação. DRC foi definida na presença de uma taxa de filtração glomerular estimada (EGFR) <60 ml / min / 1,73 CEI e estável na ausência de insuficiência renal aguda. Resultados: Foram incluídos 94 pacientes com seguimento médio de 37,2 meses; a idade média foi de 69,5 anos, 71,3% do sexo masculino. A cardiomiopatia era isquêmica em 48% e a nefropatia vascular era predominante (62%). Síndrome Cardio-renal tipo 2 foi diagnosticada em 76 (81%) pacientes. diminuição significativa da taxa de filtração glomerular entre os tempos de verificação (45 ± 10 ml / min; cerca de 2 cerca de 1 38 ± 15 ml / min; p <0,001) foi evidenciado e 50% dos pacientes tiveram a fase de Peoria DRC (p = 0,027). e morte cardiovascular (OU 10,9 associação entre a progressão DRC de DCV com maior frequência (P = 0,002), o rendimento de IC (OR 3.3, 95 % CI 1.9-11.2 p = 0,044), verificou-se IC 95% 2,9-40,1, p <0,001). Conclusões: A progressão da DRC em pacientes com HFrR ambulatorial está associada a um pior prognóstico em termos de mortalidade cardiovascular, IC e DCV

Comparación de fórmulas para la estimación del filtrado glomerular: correlación e implicancia clínica / Comparison of formulas for the estimation of glomerular filtration: correlation and clinical implication / Comparação de fórmulas para a estimativa da filtração glomerular: correlação e implicações clínicas

La Enfermedad Renal Crónica (ERC) es un importante problema de salud pública que trae aparejada una gran morbi-mortalidad. Una de las herramientas diagnósticas es la estimación del filtrado glomerular (eFG). Los objetivos de este estudio fueron comparar el eFG según dos ecuaciones: MDRD-4 y CKD-EPI, evaluar su comportamiento en valores clínicamente relevantes y evidenciar Enfermedad Renal Oculta (ERO) según cada una de las fórmulas evaluadas, clasificando a la población estudiada en estadíos de ERC. Se evaluaron 2.526 pacientes con factores de riesgo asociados a ERC. La media de los resultados obtenidos con ambas fórmulas fue: para MDRD-4 84,5 mL/min/1,73 m², y para CKD-EPI 90,9 mL/min/1,73 m². De la relación entre el eFG en sus diversos estadíos y los resultados de creatininemia resultó que 83 pacientes se clasificaron como ERO según MDRD-4, y 23 lo hicieron para CDK-EPI, con lo que se manifestó una subestimación de la eFG utilizando la ecuación MDRD-4. La importancia de este estudio radica en el hallazgo precoz y en la prevención de complicaciones que podrían limitar el bienestar de estos pacientes. La participación de Laboratorios nucleados en red brinda herramientas accesibles y de bajo costo para su asistencia temprana, en busca de seguridad, cuidado y educación del paciente.

Chronic Kidney disease (CKD) is an important public health problem which is associated to an increase in mortality. An important diagnostic tool is the estimated glomerular filtration rate (GFR). The aims of this study were to compare GFR according to two different formulas: MDRD-4 and CKD-EPI, in order to evaluate its performance in clinically relevant values and to display occult chronic kidney disease (OCKD) according to each of the equations reviewed to classify the studied population into different stages of CKD. A total of 2526 patients with CKD-associated risk factors were analyzed. Mean of the results with both formulas were: 84.5 mL/min/1.73 m² for MDRD-4 and 90.9 mL/min/1.73 m² for CKD-EPI. Considering the associations between GFR in each of the stages and the results of blood creatinine, 83 patients were classified as OCKD by MDRD-4 while 23 were classified by MDRD-EPI; showing an underestimation of the GFR when using MDRD-EPI. The importance of this study lies in the early detection of the disease and in preventing the complications that could restrict the patient’s well-being. The support of the networking laboratories brings the appropriate and low cost tools for an early assistance in search of security, care and education forthe patient.

A Doença Renal Crônica (DRC) é um importante problema de saúde pública que traz grande morbimortalidade. Uma das ferramentas de diagnóstico é a estimativa de filtração glomerular (eFG). Os objetivos deste estudo foram comparar eFG de acordo com duas equações: MDRD-4 e CKD-EPI, avaliar seu comportamento em valores clinicamente relevantes e evidenciar Doença Renal Oculta (DRO) de acordo com cada uma das fórmulas avaliadas, classificando a população estudada em estágios de DRC. Foram avaliados 2526 pacientes com fatores de risco associados à DRC. A média dos resultados obtidos com as duas formulações foi: MDRD-4 a 84,5 mL/min /1,73 m², e CKD-EPI 90,9 mL/min/1.73 m². A relação entre o eFG nas suas diversas fases e os resultados de creatininemia mostrou que 83 pacientes foram classificados como ERO segundo MDRD-4, e 23 fizeram para CDK-EPI, demonstrando uma subestimação da eFG usando a equação MDRD-EPI. A importância desse estudo está na detecção precoce e prevenção de complicações que poderiam limitar o bem-estar desses pacientes. A participação de Laboratórios reunidos em uma rede fornece ferramentas acessíveis e de baixo custo para sua assistência precoce, em busca de segurança, cuidado e educação do paciente.

Evaluación de factores de riesgo y utilidad de un modelo pediátrico predictivo de progresión a enfermedad renal estadio terminal en pacientes con enfermedad renal crónica estadios 2 al 4 atendidos en el Hospital del Niño Dr. José Renán Esquivel del 2007 al 2016 / Evaluation of risk factors and utility of a pediatric model predictive of progression to end stage renal disease in patients with chronic renal disease stages 2 to 4 attended at the Hospital del Niño Dr. José Renan Esquivel from 2007 to 2016

Introducción: El curso clínico de la enfermedad renal crónica (ERC) en la población pediátrica es heterogéneo. La incidencia de enfermedad renal estadio 5 (ERC5) en la población pediátrica está en aumento. El propósito de este estudio es evaluar los factores de riesgo y la utilidad de un modelo pediátrico predictivo de progresión estadio 5 en pacientes mayores de 2 años con ERC estadio 2-4 atendidos en el Hospital del Niño Doctor José Renán Esquivel. Materiales y métodos: Se trata de un estudio analítico de cohorte retrospectivo. Se revisaron los expedientes de los pacientes con ERC y diagnósticos afines atendidos por el Servicio de Nefrología a partir de la fecha en que se estableció el diagnóstico de ERC y luego su seguimiento al año y los 5 años de su diagnóstico inicial. Resultados: 33 pacientes ingresaron al estudio. La mediana de edad de 6 años (DE +4). Hubo 18 femeninas; 13 procedentes de la provincia de Panamá. Se realizó el análisis univariado para los factores de riesgo, obteniendo riesgo de progresión para hiperfosfatemia al primer año de seguimiento (RR = 6.750, p = 0.031) y 5 años de seguimiento (RR = 3.857, p = 0.002); no hubo significancia estadística para las otras variables estudiadas. Hubo 13 pacientes que progresaron a estadio 5. Al aplicar el modelo pediátrico predictivo de progresión a estadio 5 de Oliveira, al momento del ingreso al estudio la distribución de los pacientes fue: bajo riesgo 11, mediano riesgo 14 y alto riesgo 8, obteniendo el porcentaje de supervivencia renal a los 5 años de seguimiento para los pacientes de bajo, mediano y alto riesgo de 16 (76.1%), 2 (40%) y 2 (28.5%), respectivamente. El análisis de supervivencia renal no tuvo significancia estadística. Conclusiones: La hiperfosfatemia en pacientes pediátricos con ERC se asocia a progresión a ERC5 al primer año y 5 años de seguimiento. Se necesitan de estudios longitudinales, prospectivos y multicéntricos para evaluar la utilidad del modelo pediátrico predictivo de progresión a estadio 5 de Oliveira.

Introduction: The clinical course of chronic kidney disease (CKD) in the pediatric population is heterogeneous. The incidence of chronic kindey diseae stage 5 (CKD5) in the pediatric population has increased over the past two decades. The purpose of this study is to evaluate the risk factors and utility of a pediatric predictive model of progression to CKD5 in pediatric patients older than 2 years with chronic renal disease stage 2-4 treated at the Children's Hospital Doctor Jose Renan Esquivel. Methods: A retrospective cohort study was conducted in which the records of patients with CKD and related diagnoses were reviewed of the Children's Hospital Doctor Jose Renan Esquivel Nephrology Service, from the date of CKD diagnosis was settle down and then follow-up one year and 5 years from initial diagnosis in the period from January 2007 to December 2016. Results: 33 patients entered the study. The median age was 6 years (SD +4). There were 18 female; 13 from the province of Panama. Univariate analysis was performed for risk factors, with a risk of progression to hyperphosphatemia at the first year of follow-up (RR = 6,750, p = 0.031) and 5 years of follow-up (RR = 3,857, p = 0.002); there was no statistical significance for the other variables studied. 13 progressed to CKD5. When applying the Oliveira pediatric predictive model of progression to CKD5, 11 were at low risk, 14 at medium risk and 8 at high risk at the admission to the study, obtaining a renal survival at 5 years of follow-up, 16 (76.1%), 2 (40%) and 2 (28.5%), respectively. The analysis of renal survival was not statistically significant. Conclusions: Hyperphosphataemia in pediatric patients with CKD is associated with progression to CKD at the first year and 5 years of follow-up. Longitudinal, prospective and multicenter studies are needed to evaluate the utility of the pediatric predictive model of progression to CKD5.

Comportamiento epidemiológico en pacientes con enfermedad renal crónica terminal en Ecuador / Epidemiological behavior on patients with terminal chronic kidney disease from Ecuador

Introducción: alta prevalencia de la enfermedad renal crónica, en la población adulta de Ecuador. Objetivo: describir el comportamiento epidemiológico de la enfermedad renal crónica terminal, en pacientes atendidos en una clínica médica ecuatoriana. Método: se realizó un estudio transversal en 84 pacientes con enfermedad renal crónica terminal, en tratamiento de hemodiálisis, en la clínica DIALVIDA Ambato, Ecuador, de octubre 2016 a abril 2017. Las variables estudiadas en los pacientes con síntomas de la enfermedad fueron: causas, edad, datos generales, nivel de instrucción, ingresos económicos, estado nutricional según el índice de masa corporal, y hábito de fumar. Resultados: la edad media fue de 52 años, con predominio del sexo masculino del 63,1%. Los mayores de 60 años alcanzaron el 52,4%. La mayoría de los pacientes mostraron bajo nivel de instrucción (sin instrucción: 16,6%; secundaria: 33,3% y primaria; 36,9%). Se observó un predominio de pacientes con ingreso económico menor al salario unificado, el 60,7%, los pacientes normopeso con el 51,2%, seguido de pacientes con sobrepeso con el 25%. El 47,6% eran fumadores. Las causas principales de enfermedad renal fueron: diabetes mellitus (30,9%) e hipertensión arterial (23,8%). La enfermedad apareció con más frecuencia en adultos mayores (45,2%). Conclusiones: la enfermedad renal crónica terminal, predominó en el sexo masculino, en adultos mayores normopeso, no fumadores, y con bajo nivel de instrucción. Las dos primeras causas de enfermedad renal crónica terminal fueron: diabetesmellitus e hipertensión arterial.

Introduction: how chronic kidney disease has become a public health problem in Ecuador. Objective: to describe the epidemiological behavior of terminal chronic kidney disease in patients treated in an Ecuadorian medical clinic. Method: a descriptive cross-sectional study was carried out in 84 patients with terminal chronic kidney disease undergoing hemodialysis treatment, at the DIALVIDA Ambato clinic, from October 2016 to April 2017. The variables included age of appearance, educational level, economic income, smoking habit and nutritional status according to the index of corporal mass, which are the main causes of this disease. Results: average age was 52 years old. On males prevailed 53 patients a 63.1%; 31 female patients presented 36.9%. The most affected age groups were, with 44 patients over 60 years old, 52.4% and with 27 patients from 40 to 59 years old, 32.1%. The primary level was 31 patients with 36.9%, followed by the secondary level with 28 patients, with 33.3%. Patients without instruction presented 16.6%. A predominance of patients with economic income lower than the unified salary, was observed with 51 patients for 60.7%. Normal-weight patients with 43 for 51.2%, followed by overweight patients with 21 for 25%. Smoking habit was found in 40 patients, showing 47.6%. There was a predominance of 26 patients with diabetes mellitus for 30.9%, followed by 20 patients with hypertension to 23.8%. With 38 patients, predominance in the age of onset of the disease was observed, in those over 60 years of age to 45.2%, followed by ages 40-59 with 30 patients (35.7%). Conclusions: terminal chronic kidney disease is a health problem in the studied population. It usually appears in old normopes males, non-smokers, and with low level of education. Two leading causes of terminal chronic kidney disease were diabetes mellitus and arterial hypertension.

Investigation of minor psychiatric symptoms in patients with chronic kidney disease on hemodialysis treatment / Investigação de sintomas psiquiátricos menores em pacientes renais crônicos em tratamento hemodialítico

AIMS: To identify sociodemographic characteristics and presence of minor symptoms of anxiety and depression in patients on hemodialysis. METHODS: Cross-sectional study, carried out in the hemodialysis units of the Santas Casas de Misericórdia in Marília and Tupã, São Paulo state, Brazil, with 65 hemodialytic patients, ranging from 20 to 86 years. Initially, the mental state of the participants was evaluated in order to ensure they had conditions to understand the research objectives and to respond to the evaluation instruments. Following, the subjects answered to the socio-demographic and clinical questionnaire and the Hospital Anxiety and Depression Scale. The data were organized using relative and absolute frequencies for the categorical variables, and measures of central tendency and dispersion for the quantitative variables. In order to compare the mean scores according to the studied variables, unpaired Student's t test and Analysis of Variance were used in addition to Mann Whitney U-Test and Kruskal-Wallis test when the distribution did not present normality. The adopted level of significance was 5% (p<0.05). RESULTS: The Hospital Anxiety and Depression Scale for minor symptoms identified 42 patients with anxiety and 45 with depression. The anxiety mean scores were statistically higher in the female (10.23±4.51) than in the male (8.32±3.68) patients (p=0.034). Patients aged 31 to 41 years and 42 to 52 years had higher depression scores (12.20±1.48 and 11.16±2.50 respectively) when compared to patients aged over 52 years (9.23±3.63) and aged 20 to 30 years (5.50±2.12) (p=0.017). Patients who underwent psychotherapeutic treatment had lower scores of anxiety (1.00±1.41) compared to those who had already undergone psychotherapeutic treatment and those had never been under treatment (9.27±3.92 and 12.75±3.40 respectively) (p=0.020). CONCLUSIONS: According to the Hospital Anxiety and Depression Scale, women had higher anxiety mean scores than men. The lowest scores for anxiety and depression were present in the younger and older age groups of women, and those who underwent psychotherapy presented even lower scores. Clinical management in psychotherapy can be a positive contribution to ease the symptoms of anxiety and depression, improving the patients' ability to cope with hemodialysis.

OBJETIVOS: Identificar características sociodemográficas e a presença de sintomas menores de ansiedade e depressão em pacientes em hemodiálise. MÉTODOS: Estudo transversal, realizado nas unidades de hemodiálise das Santas Casas de Misericórdia em Marília e Tupã, estado de São Paulo, com 65 pacientes hemodialíticos, na faixa de idade entre 20 a 86 anos. Inicialmente, foi realizada avaliação do estado mental a fim de identificar se os pacientes estavam em condições de compreender os objetivos da pesquisa e de responder ao questionário sociodemográfico e clínico e a Escala de Ansiedade e Depressão Hospitalar. Os dados foram organizados utilizando frequências relativas a absolutas para as variáveis categóricas e medidas de tendência central e dispersão para as variáveis quantitativas. Para comparação dos escores médios segundo as variáveis estudadas foram utilizados teste t de Student não pareado e Análise de Variância, além do Teste U de Mann Whitney e do teste de Kruskal-Wallis quando a distribuição não apresentava normalidade. O nível de significância adotado foi de 5% (p<0,05). RESULTADOS: A Escala de Ansiedade e Depressão Hospitalar para sintomas menores identificou 42 pacientes com ansiedade e 45 com depressão. As médias dos escores de ansiedade apresentaram-se maiores nas mulheres (10,23±4,51) do que nos homens (8,32±3,68) (p=0,034). Os pacientes com idades de 31 a 41 anos e 42 a 52 anos apresentaram escores de depressão mais elevados (respectivamente 12,20±1,48 e 11,16±2,50) quando comparados aos pacientes com idades acima de 52 anos (9,23±3,63) e com idades entre 20 e 30 anos (5,50±2,12) (p=0,017). Os pacientes que realizam tratamento psicoterápico tiveram escores de ansiedade menores (1,00±1,41) em comparação aos que já haviam realizado o tratamento psicoterápico e aos que não tiveram essa intervenção (respectivamente 9,27±3,92 e 12,75±3,40) (p=0,020). CONCLUSÕES: Conforme a Escala de Ansiedade e Depressão Hospitalar, as mulheres apresentaram, em média, escores de ansiedade maiores. Os menores escores para ansiedade e depressão estavam presentes nas faixas etárias mais jovens e mais velhas, e os que faziam ou já haviam feito psicoterapia apresentaram escores menores. O manejo clínico em psicoterapia pode ser uma contribuição positiva para amenizar os sintomas de ansiedade e depressão, melhorando a capacidade dos pacientes no enfrentamento do tratamento hemodialítico.

Marcadores de daño renal en pacientes con factores de riesgo de enfermedad renal crónica / Markers of renal damage in patients with risk factors of chronic renal disease

Se efectuó un estudio descriptivo y transversal de 46 pacientes con más de 18 años de edad, pertenecientes al consultorio 34 del área de salud del municipio de Majagua, provincia Ciego de Ávila, desde septiembre de 2015 hasta febrero de 2016. A todos los integrantes de la serie se les indicaron exámenes complementarios, tales como microalbuminuria, filtrado glomerular, creatinina, conteo de Addis y urea. No se realizaron estudios imagenológicos debido a la lejanía, las dificultades con el transporte y el equipo de ultrasonografía. La alteración de los marcadores renales estuvo presente en la mitad de los afectados con factores de riesgo, lo cual permitió detectar la enfermedad renal crónica de manera precoz en ese grupo poblacional

A descriptive and cross-sectional study of 46 patients older than 18 years, belonging to the doctor's office 34 of the health area in Majagua, Ciego de Ávila, was carried out from September, 2015 to February, 2016. The complementary tests were indicated to all the members of the series, such as microalbuminuria, glomerular filtration rate, creatinine, Addis and urea counts . The imagenologic studies were not carried out due to the long distance, difficulties with the transportation and the ultrasonography equipment. The disorder of renal markers was present in half of those affected patients with risk factors, which allowed to detect earlier the chronic renal disease in that population group

Calidad de vida en adultos mayores con enfermedad renal crónica en el nivel primario de salud / Life quality in elder people with chronic renal disease in the primary health care level

Introducción: la mayoría de los estudios sobre calidad de vida relacionada a la salud se han dirigido a pacientes en terapias de sustitución renal o transplante renal. Objetivo: valorar la calidad de vida relacionada con la salud en pacientes adultos mayores enfermos renales crónicos desde el nivel primario de salud. Materiales y Métodos: se realizó un estudio observacional, descriptivo en el Consejo Popular Entronque de Pilotos, de mayo del 2014 a mayo del 2015, sobre el comportamiento de la calidad de vida en adultos mayores, con enfermedad renal crónica con estadios 1, 2 y 3 de la enfermedad. El universo fueron los 109 pacientes portadores de la enfermedad a los cuales se aplicó la "Escala MGH de calidad de vida en el adulto mayor". Se utilizaron técnicas de estadística descriptiva y se solicitó el consentimiento informado a los pacientes. Resultados: al inicio del estudio la percepción de calidad de vida de los adultos mayores era muy baja, con pocos pacientes con calidad de vida buena lo que fue modificado favorablemente al año de seguimiento. Conclusiones: se logró que los pacientes adultos mayores con enfermedad renal crónica en los estadios 1,2 y 3 del Consejo Popular Entronque de Pilotos, modificaran favorablemente su percepción de la calidad de vida relacionada con la salud, al año del diagnóstico y seguimiento de la enfermedad (AU).

Introduction: most of the studies on health-related life quality have taken into account patients in therapies of renal replacement or transplantation. Objective: to appraise health-related life quality in elder people suffering chronic renal disease from the primary health care level. Material and Methods: an observational, descriptive study in the Popular Council Entronque de Pilotos, from May 2014 to May 2015, on the behavior of the life quality of elder people with stage 1, 2 and 3 chronic renal disease. The universe was the 109 disease-carrier patients; they applied the "MGH scale of life quality in elder people". Descriptive statistic techniques were used and patients were asked their informed consent. Results: at the beginning of the study, the elder people' life quality perception was very low, having few patients with good life quality; that was favorably modified after a year follow-up. Conclusions: it was achieved the favorable modification of the health-related life quality perception of elder patients with 1, 2, and 3 stage chronic renal disease, living in the Popular Council Entronque de Pilotos, after a year of diagnosis and follow-up (AU).