Perfil sociodemográfico e laboratorial dos pacientes submetidos à hemodiálise em um centro de referência do Estado do Ceará / Sociodemographic and laboratory profile of patients undergoing hemodialysis in a reference center in the State of Ceará / Perfil sociodemográfico y de laboratorio de dos pacientes sometidos a hemodiálisis en un centro de referencia del Estado de Ceará

A Doença Renal Crônica (DRC) é uma importante redução da função renal que causa alterações no metabolismo dos indivíduos. Para acompanhar a progressão da DRC e prevenir possíveis complicações, foi realizada uma pesquisa para avaliar o perfil sociodemográfico, bioquímico e hematológico de pacientes com Insuficiência Renal Crônica (IRC) submetidos a hemodiálise. Esta pesquisa foi quantitativa, descritiva e transversal de caráter retrospectivo, realizada por meio da análise de dados secundários contidos nos prontuários dos pacientes. A coleta de dados ocorreu no Centro de Hemodiálise da cidade de Russas, no Ceará. A amostra foi constituída por 161 pacientes com DRC, sendo 63,35% do sexo masculino e 85,71% pardos, com uma idade média de 54,39 anos. Desses, 63,97% tinham entre 2 e 10 anos de tratamento e 57,76% possuíam ensino fundamental incompleto. 19,25% residiam em Russas. Resultados: Após a hemodiálise, os resultados mostraram 44 mg/dL de Ureia, 48,44% dos pacientes com valores normais. A hemoglobina e hematócrito médios foram 11,8 g/dL e 33,7%, respectivamente, sendo que 63,35% tiveram valores reduzidos. 85,10% dos pacientes tiveram contagem de plaquetas normal, 72,04% níveis adequados de ferro e albumina, 52,79% tiveram níveis elevados de ferritina, 23,61% redução de transferrina e níveis lipídicos satisfatórios. 79,50% apresentaram níveis séricos de potássio dentro da normalidade, 12,42% de fósforo acima do normal, 85,09% de cálcio dentro dos valores normais, 39,13% de PTHi normais e 86,33% de glicose dentro dos valores considerados normais. Com base nos resultados, concluiu-se que todos os pacientes em tratamento hemodialítico apresentam diversas alterações em decorrência da DRC e do próprio processo de tratamento. Portanto, a realização de exames para avaliar ou monitorar possíveis complicações da IRC é essencial para criar estratégias e intervenções mais eficazes, que melhorem a assistência prestada a esses pacientes e, consequentemente, da qualidade e expectativa de vida dos mesmos.

Chronic Kidney Disease (CKD) is an important reduction in kidney function that causes changes in the metabolism of individuals. To monitor the progression of CKD and prevent possible complications, a survey was carried out to assess the sociodemographic, biochemical and hematological profile of patients with Chronic Renal Failure (CRF) undergoing hemodialysis. This research was quantitative, descriptive and cross-sectional with a retrospective character, carried out through the analysis of secondary data contained in the patients' medical records. Data collection took place at the Hemodialysis Center in the city of Russas, Ceará. The sample consisted of 161 patients with CKD, 63.35% male and 85.71% brown, with an average age of 54.39 years. Of these, 63.97% had between 2 and 10 years of treatment and 57.76% had incomplete primary education. 19.25% resided in Russas. Results: After hemodialysis, the results showed 44 mg/dL of Urea, 48.44% of patients with normal values. Average hemoglobin and hematocrit were 11.8 g/dL and 33.7%, respectively, with 63.35% having reduced values. 85.10% of the patients had normal platelet counts, 72.04% had adequate levels of iron and albumin, 52.79% had high levels of ferritin, 23.61% had reduced transferrin and satisfactory lipid levels. 79.50% had serum levels of potassium within the normal range, 12.42% of phosphorus above normal, 85.09% of calcium within normal values, 39.13% of PTHi normal and 86.33% of glucose within the values considered normal. Based on the results, it was concluded that all patients on hemodialysis have several changes due to CKD and the treatment process itself. Therefore, carrying out tests to assess or monitor possible complications of CRF is essential to create more effective strategies and interventions that improve the care provided to these patients and, consequently, their quality and life expectancy.

La Enfermedad Renal Crónica (ERC) es una reducción importante de la función renal que provoca cambios en el metabolismo de los individuos. Para monitorizar la evolución de la ERC y prevenir posibles complicaciones, se realizó una encuesta para evaluar el perfil sociodemográfico, bioquímico y hematológico de los pacientes con Insuficiencia Renal Crónica (IRC) en hemodiálisis. Esta investigación fue cuantitativa, descriptiva y transversal con carácter retrospectivo, realizada a través del análisis de datos secundarios contenidos en las historias clínicas de los pacientes. La recolección de datos ocurrió en el Centro de Hemodiálisis de la ciudad de Russas, Ceará. La muestra estuvo constituida por 161 pacientes con ERC, 63,35% del sexo masculino y 85,71% pardos, con una edad media de 54,39 años. De estos, 63,97% tenían entre 2 y 10 años de tratamiento y 57,76% tenían primaria incompleta. El 19,25% residía en Russas. Resultados: Posterior a la hemodiálisis los resultados arrojaron 44 mg/dL de Urea, 48,44% de los pacientes con valores normales. La hemoglobina y el hematocrito medios fueron 11,8 g/dl y 33,7 %, respectivamente, con un 63,35 % con valores reducidos. El 85,10% de los pacientes presentaba plaquetas normales, el 72,04% presentaba niveles adecuados de hierro y albúmina, el 52,79% presentaba niveles elevados de ferritina, el 23,61% presentaba transferrina reducida y niveles satisfactorios de lípidos. El 79,50% presentaba niveles séricos de potasio dentro de la normalidad, el 12,42% de fósforo por encima de lo normal, el 85,09% de calcio dentro de los valores normales, el 39,13% de PTHi normal y el 86,33% de glucosa dentro de los valores considerados normales. Con base en los resultados, se concluyó que todos los pacientes en hemodiálisis tienen varios cambios debido a la ERC y al propio proceso de tratamiento. Por tanto, la realización de pruebas para evaluar o monitorizar las posibles complicaciones de la IRC es fundamental para crear estrategias e intervenciones más eficaces que mejoren la atención a estos pacientes y, en consecuencia, su calidad y esperanza de vida.

Dexmedetomidine can not reduce the incidence of acute and chronic kidney disease after laparoscopic radical nephrectomy: a propensity score matching-based analysis / 南方医科大学学报

OBJECTIVE@#To investigate the effect of dexmedetomidine (DEX) on renal function after laparoscopic radical nephrectomy.@*METHODS@#We reviewed the clinical data of 282 patients with renal cell carcinoma (RCC), who underwent laparoscopic radical nephrectomy (LRN) in the Department of Urology, Third Medical Center of PLA General Hospital from November, 2020 and June, 2022.According to whether DEX was used during the operation, the patients were divided into DEX group and control group, and after propensity score matching, 99 patients were finally enrolled in each group.The incidence of acute kidney injuries were compared between the two groups.Serum creatinine (sCr) data within 3 months to 1 year after the operation were available in 51 patients, including 26 in DEX group and 25 in the control group, and the incidence of chronic kidney disease (CKD) was compared between the two groups.@*RESULTS@#After propensity score matching and adjustment for significant covariates, there were no significant differences in postoperative levels of sCr, cystatin C (CysC), β2-microglobulin (β2-MG), hemoglobin (Hb), or C-reactive protein (CRP), extubation time, incidence of AKI, or length of hospital stay between the two groups (P>0.05).The intraoperative urine volume was significantly higher in DEX group than in the control group (P < 0.05).A significant correlation between AKI and CKD was noted in the patients (P < 0.05).The incidence of CKD did not differ significantly between the two groups (P>0.05).@*CONCLUSION@#DEX can not reduce the incidence of AKI or CKD after LRN.

Epidemiological research progress in the effects of metal exposure on kidney / 中南大学学报(医学版)

Chronic kidney disease (CKD) is suffered progressive loss of kidney function lasting more than 3 months and is classified according to the degree of kidney damage (level of proteinuria) and the decreased glomerular filtration rate (GFR). The most severe form of CKD is end-stage renal disease. The prevalence of CKD is high with fast growth rate and the disease burden has become increasingly serious. CKD has become an important public health problem threatening human health. The etiology of CKD is complex. In addition to genetic factors, environmental factors are an important cause of CKD. With the development of industrialization, environmental metal pollution has become increasingly severe, and its impact on human health has received widespread attention. A large number of studies have shown that metals such as lead, cadmium, and arsenic can accumulate in the kidney, which can cause damage to the structure and function of the kidney, and play an important role in the development of CKD. Therefore, summarizing the epidemiological research progress in the relationship between arsenic, cadmium, lead, and other metal exposures and kidney diseases can provide new ideas for the prevention and control of kidney diseases caused by metal exposure.

Prevalence of chronic kidney disease and its association with lifestyle factors in adults from 10 regions of China / 中华流行病学杂志

Objective: To investigate the distribution of chronic kidney disease (CKD) in participants from the China Kadoorie Biobank (CKB) study and evaluate the association between lifestyle risk factors and CKD. Methods: Based on the baseline survey data and follow-up data (as of December 31, 2018) of the CKB study, the differences in CKD cases' area and population distributions were described. Cox proportional hazards regression model was used to estimate the association between lifestyle risk factors and the risk of CKD. Results: A total of 505 147 participants, 4 920 cases of CKD were recorded in 11.26 year follow up with a incidence rate of 83.43/100 000 person-years. Glomerulonephropathy was the most common type. The incidence of CKD was higher in the urban area, men, and the elderly aged 60 years and above (87.83/100 000 person-years, 86.37/100 000 person-years, and 132.06/100 000 person-years). Current male smokers had an increased risk for CKD compared with non-smokers or occasional smokers (HR=1.18, 95%CI: 1.05-1.31). The non-obese population was used as a control group, both general obesity determined by BMI (HR=1.19, 95%CI: 1.10-1.29) and central obesity determined by waist circumference (HR=1.27, 95%CI: 1.19-1.35) were associated with higher risk for CKD. Conclusion: The risks for CKD varied with area and population in the CKB cohort study, and the risk was influenced by multiple lifestyle factors.

Environmental exposure to perchlorate, nitrate, and thiocyanate in relation to chronic kidney disease in the general US population, NHANES 2005-2016 / 中华医学杂志(英文版)

BACKGROUND@#Few studies have explored the impact of perchlorate, nitrate, and thiocyanate (PNT) on kidney function. This study aimed to evaluate the association of urinary levels of PNT with renal function as well as the prevalence of chronic kidney disease (CKD) among the general population in the United States.@*METHODS@#This analysis included data from 13,373 adults (≥20 years) from the National Health and Nutrition Examination Survey 2005 to 2016. We used multivariable linear and logistic regression, to explore the associations of urinary PNT with kidney function. Restricted cubic splines were used to assess the potentially non-linear relationships between PNT exposure and outcomes.@*RESULTS@#After traditional creatinine adjustment, perchlorate (P-traditional) was positively associated with estimated glomerular filtration rate (eGFR) (adjusted β: 2.75; 95% confidence interval [CI]: 2.25 to 3.26; P  < 0.001), and negatively associated with urinary albumin-to-creatinine ratio (ACR) (adjusted β: -0.05; 95% CI: -0.07 to -0.02; P  = 0.001) in adjusted models. After both traditional and covariate-adjusted creatinine adjustment, urinary nitrate and thiocyanate were positively associated with eGFR (all P values <0.05), and negatively associated with ACR (all P values <0.05); higher nitrate or thiocyanate was associated with a lower risk of CKD (all P values <0.001). Moreover, there were L-shaped non-linear associations between nitrate, thiocyanate, and outcomes. In the adjusted models, for quartiles of PNT, statistically significant dose-response associations were observed in most relationships. Most results were consistent in the stratified and sensitivity analyses.@*CONCLUSIONS@#Exposures to PNT might be associated with kidney function, indicating a potential beneficial effect of environmental PNT exposure (especially nitrate and thiocyanate) on the human kidney.

Depressive symptoms are not associated with risks of rapid renal function decline or chronic kidney disease in middle-aged and elderly with normal kidney function: a longitudinal investigation / 南方医科大学学报

OBJECTIVE@#To explore the association between depressive symptoms and the risks of rapid decline in renal function and chronic kidney disease (CKD) in middle-aged and elderly with normal kidney function.@*METHODS@#The residents aged 40- 75 years with eGFR≥60 mL·min-1·1.73 m-2 without proteinuria in Lanzhou region, who participated in the "REACTION" study carried out in 2011, were selected and followed up in 2014. A total of 4961 individuals with complete and qualified data from the two surveys were included in the subsequent analysis. Based on PHQ-9 questionnaire scores, the baseline population was divided into two groups with and without depressive symptoms. Cox proportional hazard analysis was used to compare the incidences of rapid renal function decline and CKD between the two groups and study the association of depressive symptoms with the risk of these renal conditions.@*RESULTS@#PHQ-9 questionnaire scores were not found to correlate with baseline SCr, ALB, UACR or eGFR levels among the participarts (P>0.05). After a mean follow-up time of 3.4±0.6 years, 33.9% of the participants with depressive symptoms at baseline experienced a rapid decline in renal function and 3.6% progressed to CKD. During the follow-up, the incidence of rapid decline in renal function and the risk of developing CKD were not found to correlate with depressive symptoms in these participants (P>0.05) regardless of the type of the depressive syndromes.@*CONCLUSION@#Depressive symptoms are not associated with the risks of rapid renal function decline or progression to CKD in middle-aged and elderly with normal kidney function.

Detección de factores de riesgo de enfermedad renal crónica en adultos / Detection of Risk Factors for Chronic Kidney Disease in Adults

Introducción: La enfermedad renal crónica se considera una enfermedad con graves repercusiones para la sociedad y las políticas de salud, con elevada incidencia y prevalencia debido al alza de enfermedades como la hipertensión arterial y la diabetes mellitus. Objetivo: Detectar, de forma oportuna, adultos con alto riesgo de desarrollar enfermedad renal crónica para preservar su salud, y así frenar la aparición y progresión del daño renal. Métodos: Se realizó un estudio descriptivo, transversal, cuantitativo, con 404 adultos familiares de estudiantes de enfermería, Universidad Técnica de Machala, El Oro, Ecuador. Se utilizó el Cuestionario de Detección Temprana de Riesgo de la Enfermedad Renal, del grupo Da Vita. Resultados: La hipertensión arterial fue la principal enfermedad hallada con (27,2 por ciento), seguido de la diabetes mellitus tipo II (9,4 por ciento). La prueba Chi-cuadrado no apuntó diferencia en el antecedente de hipertensión arterial entre ambos sexos (p > 0,05). De la población de estudio, 55,6 por ciento presentaba obesidad/sobrepeso, 54,7 por ciento refirió sedentarismo, 120 personas (29,7 por ciento) presentaron antecedentes familiares de ERC. Un total de 137 personas (33,9 por ciento) refirió que consumía antinflamatorios no esteroideos. El total de pacientes con hipertensión arterial y diabetes mellitus (n = 17, 4.21 por ciento), eran obesos, sedentarios, y todos presentaron antecedentes familiares de enfermedad renal crónica, por lo que se consideraron alto riesgo. Fueron enviados a consulta para estudio, además de recibir las charlas educativas. Conclusiones: El profesional de la salud puede y debe incidir en la detección temprana de la enfermedad renal crónica, mediante pesquisa y programas educativos que aumenten el conocimiento de la población susceptible(AU)

Introduction: Chronic kidney disease is considered a disease with serious repercussions for the society and health policies, with high incidence and prevalence due to the rise of diseases such as arterial hypertension and diabetes mellitus. Objective: To detect, in a timely manner, adults at high risk of developing chronic kidney disease in order to preserve their health, and thus slow the onset and progression of kidney damage. Methods: A descriptive, cross-sectional and quantitative study was carried out with 404 adult relatives of nursing students from the Technical University of Machala, El Oro, Ecuador. The questionnaire for early detection of renal disease risk of the Da Vita group was used. Results: Arterial hypertension was found as the main disease (27.2 percent), followed by type II diabetes mellitus (9.4 percent). The chi-square test showed no difference in the history of hypertension between both sexes (p > 0.05). Of the study population, 55.6 percent were obese/overweight, 54.7 percent reported a sedentary lifestyle, and 120 persons (29.7 percent) had a family history of chronic kidney disease. A total of 137 persons (33.9 percent) reported consuming nonsteroidal antiinflammatory drugs. The total of patients with arterial hypertension and diabetes mellitus (n = 17; 4.21 percent) were obese, sedentary, and had a family history of chronic kidney disease, a reason why they were considered at high risk. They were referred to consultation for study, in addition to receiving educational talks. Conclusions: The health professional can and should have an impact on the early detection of chronic kidney disease through screening and educational programs that increase the knowledge of the susceptible population(AU)

The first appointment with a nephrologist: Brazilian patients' demographic and kidney function characteristics. A retrospective study

ABSTRACT BACKGROUND: The number of nephrologists has risen slowly, compared with the prevalence of chronic kidney disease (CKD) in Brazil. Data on patients referred to nephrology outpatient clinics remains scarce. OBJECTIVE: To determine the demographic and kidney function characteristics of patients at their first appointment with a nephrologist. DESIGN AND SETTING: Retrospective study conducted at three nephrology outpatient clinics (public and private services), in São Paulo, Brazil. METHODS: From December 2019 to February 2020, we collected patient data regarding demographics, kidney function parameters and comorbidities. We then analyzed data on 394 patients who met a nephrologist for their first appointment. RESULTS: The main comorbidities were hypertension (63.7%), diabetes (33.5%) and nephrolithiasis (22.3%). Regarding CKD stages, 24.1%, 9.1%, 13.7%, 15.2%, 15.2% and 2.3% of the patients were in stages 1, 2, 3a, 3b, 4 and 5, respectively. Proteinuria was absent or mild, moderate and high in 17.3%, 15.2% and 11.7%, respectively; and 16.2% had not undergone previous investigation of serum creatinine or proteinuria (55.8%). For 17.5%, referral to a nephrologist occurred late. Patients in public services were older than those in private services (59 years versus 51 years, respectively; P = 0.001), more frequently hypertensive (69.7% versus 57.5%; P = 0.01) and reached a nephrologist later (22.4% versus 12.4%; P = 0.009). CONCLUSION: Referrals to a nephrologist were not being made using any guidelines for CKD risk and many cases could have been managed within primary care. Late referral to a nephrologist happened in one-fifth of the cases and more frequently in the public service.

Mortalidad y egresos hospitalarios por enfermedad renal crónica de causas no tradicionales / Chronic kidney disease of nontraditional causes, mortality rates and hospital discharges

Resumen Objetivo: Describir las tendencias del diagnóstico primario de defunción, el diagnóstico de egreso hospitalario así como los años de vida potencialmente perdidos de pacientes con enfermedad renal crónica compatible con enfermedad renal crónica de causas no tradicionales según datos registrados en bases de acceso público en el país entre 2014 y 2019. Métodos: Se efectuó un estudio longitudinal descriptivo de la información sobre defunciones y egresos hospitalarios registrada en bases de datos de acceso público sobre el diagnóstico primario de enfermedad renal crónica compatible con enfermedad renal crónica de causas no tradicionales. Con los resultados obtenidos se calcularon porcentajes y frecuencias absolutas y relativas de la mortalidad y los egresos hospitalarios. Las tasas de mortalidad general, específica y ajustada fueron calculadas por el método directo. Además, se estimaron, por provincia y sexo, los años de vida potencialmente perdidos en el país. Resultados: En Costa Rica, entre 2014 y 2019, se registraron 2548 muertes y 1893 egresos hospitalarios relacionados con la Enfermedad Renal Crónica de Causas no tradicionales. Se encontró que las tasas de mortalidad ajustadas fueron elevadas para las provincias de Guanacaste y Limón en comparación con las tasas nacionales y con respecto a las de otras provincias. En la provincia de Guanacaste, además, la tendencia de egresos resultó elevada. Adicionalmente, se detectó que los años de vida potencialmente perdidos evidenciaron un incremento progresivo y constante en el país, predominantemente en el sexo masculino y en la provincia de Guanacaste. Se reportaron trece defunciones de personas menores de veinte años de edad. Conclusión: La actualización de los datos en las tendencias de mortalidad ha permitido identificar que las provincias de Guanacaste y Limón presentan tasas ajustadas superiores a la media nacional, así como menores edades promedio de defunción según el resto de las provincias. Las defunciones y egresos hospitalarios en personas menores de veinte años de edad sugieren daño renal temprano y no relacionado con enfermedad ocupacional. La mortalidad y los años de vida potencialmente perdidos proporcionan información sobre la carga de enfermedad en la población del país. Se debe agregar que la codificación específica para vigilar la patología estaba escasamente registrada en el periodo de estudio.

Abstract Aim: To describe the trends of the primary diagnosis of death, the diagnosis of hospital discharge, as well as years of potential life lost by patients with chronic kidney disease compatible with chronic kidney disease of non-traditional causes according to data registered in public access databases in the country between 2014 and 2019. Methods: A longitudinal descriptive study of the information on deaths and hospital discharges registered in public access databases on the primary diagnosis of chronic kidney disease compatible with chronic kidney disease of non-traditional causes was carried out. With the results obtained, absolute and relative percentages and frequencies were calculated for mortality and hospital discharges. The general, specific, and adjusted mortality rates were calculated by the direct method. In addition, years of potential life lost in the country were estimated by province and sex. Results: In Costa Rica, between 2014 and 2019, 2,548 deaths and 1,893 hospital discharges related to chronic kidney disease of non-traditional causes were recorded. Adjusted mortality rates were found to be elevated for the provinces of Guanacaste and Limón compared to national rates and relative to other provinces. In the province of Guanacaste, in addition, the trend of discharges was high. Additionally, it was detected that years of potential life lost showed a progressive and constant increase in the country, predominantly in the male sex and in the province of Guanacaste. Thirteen deaths of persons under twenty years of age were reported. Conclusion: Updating the data on mortality trends has made it possible to identify that the provinces of Guanacaste and Limón have adjusted rates higher than the national average, as well as lower average ages of death according to the rest of the provinces. Deaths and hospital discharges in people under 20 years of age suggest early kidney damage unrelated to occupational disease. Mortality and lost years of potential life lost provide information on the burden of disease in the country's population. It should be added that the specific coding to monitor the pathology was scarcely recorded in the study period.

Diálisis peritoneal de inicio urgente en pacientes con COVID-19 en una ciudad de gran altura / Urgent start peritoneal dialysis in patients with COVID-19 in a high rise city

Estimado director: La COVID-19 afecta a los pacientes con enfermedad renal crónica (ERC) en diálisis,1,2 ya que estos presentan factores de riesgo para desarrollar enfermedad grave, como diabetes mellitus, hipertensión arterial y edad mayor de 65 años. A esto se une la uremia, la inflamación crónica, el trastorno mineral óseo y la diálisis condicionan inmunosupresión crónica.3 La uremia produce cambios en la inmunidad innata y adaptativa y condiciona la disminución de la habilidad bactericida de los neutrófilos, la hiporeactividad de monocitos y diferenciación disminuida de células dendríticas, respuesta de células T alteradas, activación de la apoptosis inducida de células T y B, disminución de linfocitos B, cambios en la relación Th1/Th2 y disminución en número y actividad de células "natural killers".4,5 Además, en la ERC existe una alteración del sistema renina-angiotensina-aldosterona y de la relación ECA/ECA-2, que condiciona mayor susceptibilidad y peores resultados ante la infección por COVID-19.6 A pesar de ello, en diálisis, se ha reportado una cifra elevada de pacientes asintomáticos7 y también, síntomas gastrointestinales como náuseas, vómitos y diarrea,8,9 que son factores que provocan la diseminación de la enfermedad. Resalta la presencia de linfopenia y el patrón de vidrio esmerilado en gran número de pacientes, aunque también es frecuente la neumonía bilateral.6 Igualmente, los índices neutrófilo/linfocito y plaquetas/linfocitos se identifican como marcadores pronósticos tempranos de severidad de COVID-19 incluso en pacientes en hemodiálisis.10,11,12 Los pacientes con ERC deben continuar la terapia dialítica antes, durante o tras la infección por COVID-19. En ese sentido, se ha planteado que la diálisis peritoneal podría minimizar el riesgo de contraer la enfermedad por ser una terapia domiciliaria. Su uso en pacientes con falla renal y COVID-19 es segura, ya que brinda estabilidad hemodinámica, no precisa de anticoagulación ni de acceso vascular, puede iniciarse en forma aguda sin mayores complicaciones, disminuye la exposición del personal, puede ser monitorizada por teleconsulta y sus resultados son similares en comparación a las técnicas extracorpóreas.13,14,15 Presentamos nuestra experiencia en el manejo de cuatro pacientes con ERC, con infección por COVID-19 e iniciaron diálisis peritoneal, al no contar con hemodiálisis hospitalaria en su Centro Asistencial en Juliaca, Perú; ubicada a 3 827 metros sobre el nivel del mar. Dos de ellos eran hombres y tres tenían antecedente de hipertensión arterial. Los cuatro fueron hospitalizados en área COVID-19 y realizaron diálisis peritoneal manual, recibieron entrenamiento a cargo de la enfermera del programa por vía telefónica, por WhatsApp y mediante videos grabados previamente. Hubo complicaciones médicas y quirúrgicas relacionadas a la inserción del catéter en dos pacientes y se utilizó en forma aguda y urgente con un tiempo máximo de 36 h tras la cirugía. Las principales características de los pacientes se presentan en la tabla 1 y sus exámenes de laboratorio en la tabla 2. Al alta, dos de ellos...(AU)

Caracterización clínico-epidemiológica de la urolitiasis / Clinical-epidemiological description of urolithiasis

Introducción: Las urolitiasis ocasionan dolor, deterioro funcional renal y notorias erogaciones económicas. Objetivos: Identificar las características clínico-epidemiológicas de la nefrolitiasis. Métodos: Estudio descriptivo, transversal. Se estudiaron 2 923 personas pertenecientes a tres consultorios del Policlínico Plaza; municipio Plaza de la Revolución, provincia La Habana, Cuba., seleccionados por muestreo simple aleatorio de los 16 con que cuenta el área de salud. Los datos se obtuvieron mediante encuesta y entrevista estructurada. La información fue procesada de forma automatizada (IBMSPSS 22.0). Se utilizó análisis de distribución de frecuencias, se calcularon tasas de prevalencia, y fue empleado el test de homogeneidad. Resultados: La prevalencia de urolitiasis fue de 4,99 por cada 100 habitantes, de 6,3 entre los varones y de 5,7 en los de piel blanca. La edad promedio al diagnóstico fue de 39,3 años. Entre los factores de riesgo de litiasis predominó la alta ingestión de oxalatos (97,3 por ciento). La ecografía fue la forma de diagnóstico más usada (67,8 por ciento). La fitoterapia fue el tratamiento médico más utilizado (69,2 por ciento). Al 16,4 por ciento de los pacientes se les expidió certificado médico en los últimos dos años. Conclusiones: La prevalencia de litiasis urinaria en el Policlínico Docente Plaza de la Revolución es elevada, con predominio en el sexo masculino, en sujetos de piel blanca y en las edades medias de la vida. La alta ingestión de oxalato es el factor de riesgo de litiasis urinaria más frecuente encontrado. La forma de diagnóstico más utilizada es la ecografía y el tratamiento más empleado es la fitoterapia(AU)

Introduction: Urolithiasis causes pain, renal functional deterioration and notorious economic expenses. Objectives: To identify the clinical-epidemiological characteristics of nephrolithiasis. Methods: A descriptive, cross-sectional study was conducted in a total of 2,923 people from to three clinics of Plaza de la Revolution Teaching Community Clinic, Plaza de la Revolution municipality, Havana province, Cuba. They were selected by simple random sampling from the 16 clinics that the health area has. The data was obtained through a survey and structured interview. The information was processed automatically (IBMSPSS 22.0). Frequency distribution analysis was used, prevalence rates were calculated and the homogeneity test was used. Results: The prevalence of urolithiasis was 4.99 per 100 inhabitants, 6.3 among men and 5.7 among white-skinned men. The average age at diagnosis was 39.3 years. Among the risk factors for lithiasis, the high intake of oxalates prevailed (97.3 percent). Ultrasound was the most used form of diagnosis (67.8 percent). Phytotherapy was the most used medical treatment (69.2 percent). A medical permit was issued to 16.4 percent of the patients in the last two years. Conclusions: The prevalence of urinary lithiasis in Plaza de la Revolution Teaching Community Clinic is high, prevailing in males, in white-skinned and middle aged subjects. High oxalate intake is the most common risk factor for urinary lithiasis found. The most used form of diagnosis is ultrasound and the most used treatment is phytotherapy(AU)

Razão oferta/necessidade de consultas médicas, exames de diagnóstico e acompanhamento da doença renal crônica no Sistema Único de Saúde: estudo descritivo, estado de São Paulo, 2019 / Relación oferta/necesidad de consultas médicas, pruebas diagnósticas y seguimiento de la enfermedad renal crónica en el Sistema Único de Salud: estudio descriptivo, São Paulo, Brasil, 2019 / Supply/demand ratio for medical consultations, diagnostic tests and chronic kidney disease monitoring in the Brazilian National Health System: a descriptive study, state of São Paulo, Brazil, 2019

Objetivo: Determinar a razão oferta/necessidade de procedimentos relacionados com o diagnóstico e assistência à doença renal crônica no Sistema Único de Saúde (SUS), no estado de São Paulo, Brasil, 2019. Métodos: Estudo descritivo, utilizando dados dos sistemas de informações ambulatoriais e hospitalares do SUS. Os números de consultas médicas e exames diagnósticos e de acompanhamento da doença renal realizados no período foram comparados com as estimativas de necessidade obtidas por diretrizes ministeriais. Resultados: Usuários exclusivos do SUS eram 28.791.244, e indivíduos com hipertensão e/ou diabetes mellitus, 5.176.188. O número de procedimentos realizados e a razão entre esse número e a necessidade da população foram de 389.414 consultas com nefrologista (85%); 11.540.371 dosagens de creatinina sérica (223%); 705.709 dosagens de proteinúria (14%); 438.123 ultrassonografias renais (190%); e 1.045 biópsias renais (36%). Conclusão: Na assistência à doença renal crônica no SUS existem, simultaneamente, falta de oferta, desperdício e rastreamento deficiente de procedimentos importantes.

Objetivo: Determinar la relación oferta/necesidad de procedimientos relacionados con el diagnóstico y atención de la enfermedad renal crónica en Sistema Único de Salud (SUS) del Estado de São Paulo, Brasil, en 2019. Métodos: Estudio descriptivo utilizando datos de los sistemas de información ambulatoria y hospitalaria del SUS. Se comparó el número de consultas médicas, pruebas de diagnóstico y seguimiento de la enfermedad renal realizados con las estimaciones de necesidad recomendadas por directrices ministeriales. Resultados: Los usuarios exclusivos de SUS fueron 28.791.244 e hipertensos y/o diabéticos, 5.176.188. El número de procedimientos realizados y la relación entre este número y la necesidad de la población fueran de 389.414 consultas con nefrólogo (85%); 11.540.371 determinaciones de creatinina sérica (223%); 705.709 determinaciones de proteinuria (14%); 438.123 ecografías renales (190%); y 1.045 biopsias renales (36%). Conclusión: En la atención de enfermedad renal en SUS existe, simultáneamente, falta de oferta, desperdicio y seguimiento deficiente de procedimientos importantes.

Objective: To determine the supply/demand ratio for procedures related to diagnosis and treatment for chronic kidney disease in the Brazilian National Health System (SUS), in the state of São Paulo, Brazil, 2019. Methods: This was a descriptive study, using data from the SUS outpatient and hospital information systems. The numbers of medical consultations, diagnostic and chronic kidney disease monitoring tests, performed in the period, were compared with the demand estimation, obtained through ministerial guidelines. Results: Exclusive SUS users were 28,791,244, and individuals with arterial hypertension and/or diabetes mellitus, 5,176,188. The number of procedures performed and the ratio between this number and the needs of the population were 389,414 consultations with nephrologists (85%); 11,540,371 serum creatinine tests (223%); 705,709 proteinuria tests (14%); 438,123 kidney ultrasounds (190%); and 1,045 kidney biopsies (36%). Conclusion: In the chronic kidney disease care in the SUS it could be seen simultaneous existence of lack of supply, waste and inadequate screening of important procedures.

Autorrelato de diagnóstico médico de doença renal crônica: prevalência e características na população adulta brasileira, Pesquisa Nacional de Saúde 2013 e 2019 / Autoreporte de diagnóstico médico de enfermedad renal crónica: prevalencia y características encontradas en la población adulta brasileña, Encuesta Nacional de Salud 2013 y 2019 / Self-report of medical diagnosis of chronic kidney disease: prevalence and characteristics in the Brazilian adult population, National Health Survey 2013 and 2019

Objetivo: Estimar a prevalência de doença renal crônica (DRC) na população adulta brasileira e descrever suas características, segundo a Pesquisa Nacional de Saúde (PNS) de 2013 e 2019. Métodos: Estudo transversal descritivo, com adultos participantes da PNS, a partir de autorrelato de diagnóstico médico de DRC. As prevalências de DRC e seus respectivos intervalos de confiança de 95% (IC95%) foram estimados para o Brasil. Resultados: Em 2013, foram analisados 60.202 indivíduos, e, em 2019, 85.854. A prevalência de diagnóstico autorreferido de DRC nas duas edições da PNS foi de 1,4% e crescente com o aumento da faixa etária. Em 2019, a prevalência foi de 3,3% (IC95% 2,9;3,7) nos hipertensos, 4,1% (IC95% 3,4;5,0) entre diabéticos e 3,3% (IC95% 2,8;3,9) nos que referiram hipercolesterolemia. Conclusão: A prevalência de DRC no Brasil manteve-se estável no período, mas reforça-se a necessidade de ampliação do diagnóstico e do fortalecimento da atenção primária no Sistema Único de Saúde (SUS).

Objetivo: Estimar la prevalencia de enfermedad renal crónica (ERC) en la población adulta brasileña y describir sus características, según la Encuesta Nacional de Salud (PNS) del año 2013 y 2019. Métodos: Estudio descriptivo transversal, con adultos participantes en la PNS, basado en el diagnóstico médico autodeclarado de ERC. Se estimaron las prevalencias de ERC e intervalos de confianza del 95% (IC95%) para Brasil. Resultados: En 2013 se analizaron 60.202 individuos y en 2019, 85.854. La prevalencia del diagnóstico autodeclarado de ERC en ambas ediciones fue del 1,4% y aumentó con la edad. En 2019, la prevalencia fue del 3,3% (IC95% 2,9;3,7) en los hipertensos, del 4,1% (IC95% 3,4;5,0) en los diabéticos y del 3,3% (IC95% 2,8;3,9) en los que declararon hipercolesterolemia. Conclusión: La prevalencia de la ERC en Brasil se mantuvo estable, pero refuerza la necesidad de ampliar el diagnóstico y fortalecer el Sistema Único de Salud brasileño (SUS).

Objective: To estimate the prevalence of chronic kidney disease (CKD) in the adult Brazilian population and to describe its characteristics, according to the National Health Survey (PNS) 2013-2019. Methods: Descriptive cross-sectional study, with adults participating in the PNS, based on self-reported medical diagnosis of CKD. Prevalence of CKD and their respective 95% confidence intervals (95%CI) were estimated for Brazil. Results: In 2013, 60,202 individuals were analyzed, and in 2019, 85,854. The prevalence of self-reported diagnosis of CKD in both editions was 1.4% and increased with increasing age. In 2019, the prevalence of self-reported CKD was 3.3% (95%CI 2.9;3.7) in hypertensive individuals, 4.1% (95%CI 3.4;5.0) among diabetics, and 3.3% (95%CI 2.8;3.9) in those reporting hypercholesterolemia. Conclusion: The prevalence of CKD in Brazil remained stable in the period but reinforces the need for expansion of diagnosis and strengthening of primary care in the Brazilian National Health System (SUS).

Quality indicators for primary health care in chronic kidney disease in the public service of a city in the State of São Paulo, Brazil / Qualidade de atenção primária em doença renal crônica em um serviço público de um município do Estado de São Paulo, Brasil / Calidad de los cuidados de salud en la atención primaria relacionados con la enfermedad crónica de riñón en un servicio público en una ciudad del Estado de São Paulo, Brasil

Abstract: Complications of chronic kidney disease (CKD) can be avoided when promptly diagnosed and treated. The objective was to describe quality indicators of CKD detection and health care in the primary care public service of a city in the State of São Paulo, Brazil. This retrospective study analyzed charts of patients who attended primary care in the public service between November 2019 and February 2020. We selected 10 health quality indicators based on their scientific relevance and availability from the medical records that could express how CKD was identified and managed in primary health care. We estimated the adequate percentage of health indicators with data from 1,066 individuals who had ≥ one risk factor for CKD: hypertension, diabetes, or > 60 years old. Among patients, 79.4% had information on serum creatinine, whereas 58.8% were investigated for proteinuria. Blood pressure data were found in 98.9% of the records. The percentage of patients with blood pressure < 140x90mmHg, glycosylated hemoglobin < 6.5% and LDL-cholesterol < 100mg/dL was 79.2%, 49.2%, and 33.3%, respectively. Renin-angiotensin system blockers were prescribed to 82.8% of the patients with hypertension and CKD. Serum potassium was measured in 35.7% for those who were using renin-angiotensin system blockers. Among those people with CKD, 16.7% had CKD assigned in the medical records as a diagnose. Among those participants at higher risk for CKD, the referral rate to a nephrologist was 31.6%. This study confirmed some missed quality indicators of CKD in primary healthcare. Our results may help administrators develop public policies that improve health care for individuals at high risk for CKD. Long-term follow-up of the health indicators we proposed here will be useful to assess the impact of policy intervention.

Resumo: As complicações da doença renal crônica (DRC) podem ser evitadas quando a doença é diagnosticada e tratada oportunamente. O estudo teve como objetivo descrever a qualidade dos indicadores da detecção e assistência para a DRC no sistema púbico de saúde em um município do Estado de São Paulo, Brasil. O estudo retrospectivo analisou prontuários de pacientes que utilizaram serviços de atenção primária no sistema público entre novembro de 2019 e fevereiro de 2020. Selecionamos dez indicadores de qualidade com base na relevância científica e disponibilidade, a partir dos prontuários médicos. Calculamos o percentual de adequação com dados de 1.066 indivíduos que apresentavam ≥ 1 fatores de risco para DRC: hipertensão, diabetes ou idade > 60 anos. No total, 79,4% dos pacientes apresentavam informação sobre creatinina sérica, e 58,8% foram investigados para proteinúria. Dados de pressão arterial foram encontrados em 98,9% dos prontuários. As proporções de pacientes com pressão arterial < 140x90mmHg, hemoglobina glicada < 6,5% e LDL < 100mg/dL foram 79,2%, 49,2% e 33,3%, respectivamente. Os antagonistas do sistema renina-angiotensina foram prescritos em 82,8% dos pacientes com hipertensão e DRC. O potássio sérico foi medido em 35,7% dos pacientes em uso de antagonistas do sistema renina-angiotensina. Entre os indivíduos com DRC, 16,7% tinham esse diagnóstico registrado no prontuário médico. Entre os participantes com risco mais elevado de DRC, 31,6% foram encaminhados para um nefrologista. O estudo confirmou a falta de alguns indicadores de qualidade para DRC na assistência primária. Os resultados podem ajudar gestores a desenvolverem políticas públicas que melhorem a assistência para indivíduos com risco maior de DRC. O seguimento a longo prazo dos indicadores de saúde propostos aqui será útil para avaliar o impacto dessa política de intervenção.

Resumen: Las complicaciones de la enfermedad crónica de riñón (ECR) se pueden evitar cuando esta enfermedad se diagnostica con prontitud y se trata. El objetivo fue describir indicadores de calidad en la detección de ECR, así como la asistencia en el servicio público de una ciudad, en el Estado de São Paulo, Brasil. Este estudio retrospectivo analizó fichas de pacientes que acudían a atención primaria en el servicio público, entre noviembre 2019 y febrero 2020. Seleccionamos 10 indicadores de calidad en salud, basados en relevancia científica y disponibilidad de registros médicos. Calculamos el porcentaje de adecuación de ellos con datos de 1.066 personas que tenían ≥ 1 factor de riesgo ECR: hipertensión, diabetes, o > 60 años. Un 79,4% de los pacientes tenían información sobre la creatinina sérica, y se investigó a un 58,8% en el caso de la proteinuria. Los datos de presión sanguínea se encontraron en un 98,9% de los registros. El porcentaje de pacientes con presión sanguínea < 140x90mmHg, hemoglobina glicada < 6,5% y LDL < 100mg/dL fue 79,2%, 49,2%, y 33,3%, respectivamente. Se prescribieron bloqueadores del sistema renina-angiotensina a un 82,8% de los pacientes con hipertensión y ECR. Se midió el potasio sérico en un 35,7% de aquellos quienes estaban usando bloqueadores del sistema renina-angiotensina. Entre aquellas personas con ECR, 16,7% había ECR asignado en los registros médicos como diagnosis. Entre aquellos participantes en riesgo mayor por ECR, la tasa de derivación a un nefrólogo fue 31,6%. Este estudio confirmó algunos indicadores de calidad olvidados de ECR en los cuidados de salud en la atención primaria. Nuestros resultados quizás podrían ayudar a los gestores a desarrollar políticas públicas que mejoraran el cuidado de salud para las personas con alto riesgo de ECR. El seguimiento a largo plazo de los indicadores de salud que propusimos aquí será útil para evaluar el impacto de la política de intervención.

Detección de enfermedad renal crónica oculta mediante determinación de albuminuria en pacientes con diabetes mellitus / Detection of Hidden Chronic Kidney Disease by Determining Albumin Estimates in Patients with Diabetes Mellitus

Introducción: La diabetes mellitus constituye la segunda causa de enfermedad renal crónica en Cuba. La estimación de albuminuria facilitaría la identificación precoz de esta. Objetivo: Determinar el valor predictor de enfermedad renal crónica oculta en la albuminuria de pacientes con diabetes mellitus de la Atención Primaria de Salud en Las Tunas. Métodos: Se realizó un estudio analítico de caso-control en 360 pacientes con diabetes mellitus pertenecientes al Policlínico Manuel Fajardo Rivero, en el período de enero de 2019 a febrero de 2020. La población en estudio fue dividida en dos grupos, atendiendo a la presencia (casos) o no (controles) de daño renal. El poder discriminatorio de la albuminuria como predictor de enfermedad renal crónica oculta se determinó mediante el área bajo la curva ROC, además se identificó el punto de corte óptimo. Se utilizó el análisis multivariado para identificar los factores predictores independientes de enfermedad renal. Resultados: La albuminuria mayor de 160 mg/24h fue identificada como predictor de enfermedad renal crónica oculta (OR: 2,278; IC de 95 por ciento: 1,637-2,908) junto a la edad ˃ 65 años, los años de evolución de DM ˃ 8 años y la hipoalbuminemia. El poder discriminatorio fue bueno, índice C: 0,843 (IC de 95 por ciento: 0,762-0,929). El punto de corte identificado de 160 mg/24h alcanzó una sensibilidad y especificidad de 90,00 por ciento y 97,60 por ciento, respectivamente. Conclusiones: La albuminuria pudiese ser un importante predictor independiente de enfermedad renal crónica oculta en pacientes con diabetes mellitus de la Atención Primaria de Salud(AU)

Introduction: Diabetes mellitus is the second cause of chronic kidney disease in Cuba. Albumin estimates would facilitate its early identification. Objective: To determine the predictive value of albuminuria in hidden chronic kidney disease among patients with diabetes mellitus at primary healthcare level in Las Tunas. Methods: An analytical case-control study was carried out in 360 patients with diabetes mellitus belonging to Manuel Fajardo Rivero Polyclinic, in the period from January 2019 to February 2020. The study population was divided into two groups: occurrence (cases) or not (controls) of kidney damage. The discriminatory power of albuminuria as a predictor of hidden chronic kidney disease was determined by the area under the ROC curve, while its optimal cut-off point was also identified. Multivariate analysis was used to identify independent predictors of kidney disease. Results: Albuminuria over 160 mg on 24 hours was identified as a predictor of hidden chronic kidney disease (OR: 2.278; 95 percent CI: 1.637-2.908) together with age over 65 years, evolution of diabetes mellitus over 8 years, and hypoalbuminemia. The discriminatory power was good: The C index was 0.843 (95 percent CI: 0.762-0.929). The identified cut-off point of 160 mg in 24 hours reached a sensitivity and specificity of 90.00 percent and 97.60 percent, respectively. Conclusions: Albuminuria could be an important independent predictor of hidden chronic kidney disease in patients with diabetes mellitus at primary healthcare level(AU)

Short- and mid- term impact of tobacco smoking on donor renal function following living kidney donation at a tertiary referral hospital

Background: The negative impact of tobacco smoking on renal function has been widely studied. However, there is limited knowledge about the effect of smoking on pre-operative and post-operative renal function in living kidney donors. Objective: The objective of the study was to evaluate the short- and mid-term impact of smoking on donor renal function. Methods: This is a retrospective study of 308 patients who underwent living donor nephrectomy (LDN) at a tertiary referral hospital. We compared baseline characteristics as well as functional outcomes following LDN according to history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation in 6 time periods: pre-operative, 1 week, 1 month, 6 months, 12 months, and 24 months after surgery. We performed a Kaplan-Meier analysis for chronic kidney disease (CKD) outcome and binary logistic regression analysis to identify risk factors associated with CKD at 24 months of follow-up. Results: Among donors, 106 (34.4%) reported a smoking history before nephrectomy. Smoking donors had worse pre-operative eGFR than non-smokers (90 ± 26.3 mL/min/1.73m2 vs. 96 ± 27 mL/min/1.73 m2, respectively; p = 0.02) and lower eGFR at 1 week (p = 0.01), 1 month (p ≤ 0.01), 6 months (p = 0.01), and 12 months (p = 0.01) after LDN. Tobacco smoking (OR 3.35, p ≤ 0.01) and age ≥ 40 years at donation (OR 6.59, p ≤ 0.01) were associated with post-operative development of CKD at 24 months after LDN. Conclusions: Living kidney donors with a tobacco smoking history had an increased risk of developing chronic kidney disease following nephrectomy. Smoking-cessation strategies should be implemented.

Diferenças entre medidas autorreferidas e laboratoriais de diabetes, doença renal crônica e hipercolesterolemia / Differences between self-reported and laboratory measures of diabetes, chronic kidney disease, and hypercholesterolemia

Resumo O objetivo deste artigo é comparar as prevalências autorreferidas e medidas por exames laboratoriais, assim como a ocorrência de valores de falsos positivos e negativos, para diabetes, doença renal crônica e hipercolesterolemia. Foram utilizadas informações da entrevista e exames laboratoriais da Pesquisa Nacional de Saúde (2013, 2014-2015). Foram calculadas a sensibilidade e a especificidade, segundo sexo, idade, escolaridade, ter plano de saúde e tempo desde a última consulta médica. Por meio de regressão logística, foram analisados fatores associados à ocorrência de falsos positivos e falsos negativos. A sensibilidade foi mais elevada para o diabetes e entre os idosos e os que tiveram consulta médica mais recentemente. A especificidade foi alta para todas as doenças, com melhor desempenho entre os jovens, os com alta escolaridade e os que consultaram há mais de um ano. As chances de falsos positivos e falsos negativos diminuíram com a escolaridade e aumentaram com a idade. A sensibilidade baixa indica que as prevalências podem ser mais elevadas que as medidas autoreferidas apontam.

Abstract This paper aims to compare the self-reported prevalence measured by laboratory tests and the false positive and negative values for diabetes, chronic kidney disease, and hypercholesterolemia. We used information from the interview and laboratory tests of the National Health Survey (2013, 2014-2015). Sensitivity and specificity were calculated by gender, age, schooling, having health insurance, and time since the last medical visit. We used logistic regression to analyze associated factors with false positives and negatives. Sensitivity was higher for diabetes and among older adults and those who had a medical visit more recently. Specificity was high for all diseases, with better performance among younger people, those with high schooling, and a visit more than one year ago. The likelihood of false positives and negatives decreased with schooling and increased with age. Low sensitivity suggests that prevalence might be higher than indicated by self-reported measures.

Screening of family members of chronic kidney disease patients with Fabry disease mutations: a very important and underrated task / Triagem de familiares de pacientes com doença renal crônica com mutação na doença de Fabry: uma tarefa muito importante e subestimada

ABSTRACT Introduction: Fabry disease is a chronic, progressive, and multi-system hereditary condition, related to an Xq22 mutation in X chromosome, which results in deficiency of alpha-galactosidase enzyme, hence reduced capacity of globotriaosylceramide degradation. Objectives: to evaluate the prevalence of Fabry disease (FD) mutations, as well as its signs and symptoms, among relatives of chronic kidney disease (CKD) patients diagnosed with FD during a previously conducted study, named "Clinical and epidemiological analysis of Fabry disease in dialysis centers in Brazil". Methods: a cross-sectional study was carried out, and data was collected by interviewing the relatives of patients enrolled in the Brazil Fabry Kidney Project and blood tests for both Gb3 dosage and genetic testing. Results: Among 1214 interviewed relatives, 115 (9.47%) were diagnosed with FD, with a predominance of women (66.10%). The most prevalent comorbidities were rheumatologic conditions and systemic hypertension (1.7% each), followed by heart, neurological, cerebrovascular diseases, and depression in 0.9% of individuals. Intolerance to physical exercise and tiredness were the most observed symptoms (1.7%), followed by periodic fever, intolerance to heat or cold, diffuse pain, burn sensation or numbness in hands and feet, reduced or absent sweating, as well as abdominal pain after meals in 0.9%. Conclusion: We found a prevalence of Fabry disease in 9.47% of relatives of CKD patients with this condition, remarkably with a 66.1% predominance of women, which contrasts with previous reports. The screening of family members of FD patients is important, since it can lead to early diagnosis and treatment, thus allowing better quality of life and improved clinical outcomes for these individuals.

RESUMO Introdução: A doença de Fabry é uma condição hereditária crônica, progressiva e multissistêmica, relacionada a uma mutação Xq22 no cromossomo X, que resulta em deficiência da enzima alfa-galactosidase, diminuindo a capacidade de degradação da globotriaosilceramida. Objetivos: avaliar a prevalência de mutações na doença de Fabry, bem como seus sinais e sintomas, em familiares de pacientes com doença renal crônica (DRC) diagnosticados com DF durante um estudo realizado anteriormente, denominado "Análise clínica e epidemiológica da doença de Fabry em centros de diálise no Brasil". Métodos: foi realizado um estudo transversal e os dados foram coletados através da entrevista com familiares de pacientes inscritos no Projeto Rim Fabry Brasil e exames de sangue para dosagem de Gb3 e testes genéticos. Resultados: Dos 1,214 familiares entrevistados, 115 (9,47%) foram diagnosticados com DF, com predomínio de mulheres (66,10%). As comorbidades mais prevalentes foram condições reumatológicas e hipertensão arterial sistêmica (1,7% cada), seguidas por doenças cardíacas, neurológicas, cerebrovasculares e depressão em 0,9% dos indivíduos. Intolerância ao exercício físico e cansaço foram os sintomas mais observados (1,7%), seguidos de febre periódica, intolerância ao calor ou ao frio, dor difusa, sensação de queimação ou dormência nas mãos e nos pés, sudorese reduzida ou ausente, além de dor abdominal após refeições em 0,9%. Conclusão: Encontramos uma prevalência da doença de Fabry em 9,47% dos familiares de pacientes com DRC com essa condição, notadamente com uma predominância de 66,1% de mulheres, o que contrasta com relatos anteriores. A triagem de familiares de pacientes com DF é importante, pois pode levar ao diagnóstico e tratamento precoces, permitindo melhor qualidade de vida e melhores resultados clínicos para esses indivíduos.

Evaluación de la función renal en adultos mayores / Evaluation of kidney function in older adults

The evaluation of renal function in older adults is usually carried out with a creatinine clearance or an estimation of glomerular filtration rate using formulas such as Cockcroft-Gault, MDRD or CKD-EPI. The results obtained with these formulas are often regarded as equivalent. However, in adults older than 70 years, the Cockcroft-Gault formula frequently underestimates the glomerular filtration rate with respect to reference methods and the MDRD formula overestimates it. CKD-EPI has a more unpredictable behavior. This leads to erroneously classifying patients in the stages of chronic kidney disease (CKD), artificially increasing the prevalence of this condition, overloading health systems and generating emotional disorders in patients mistakenly classified as carriers of CKD. Also, when kidney function is overestimated, CKD patients are prevented from receiving the treatments appropriate for their condition. In recent years, new formulas have been proposed (FAS, BIS) with a greater accuracy to estimate glomerular filtration rate in older adults. This review describes the behavior of these formulas in a significant number of older adults, from various countries, and proposes using those equations with the best performance in older adults.

Doença renal crônica em adultos de Rio Branco, Acre: inquérito de base populacional / Chronic kidney disease among adults in Rio Branco, State of Acre: a population-based survey

Resumo O objetivo do presente estudo foi verificar a prevalência de DRC e os fatores a ela associados em adultos jovens (18-59 anos) de Rio Branco, Acre. Trata-se de um inquérito de base populacional realizado em 2014, nas zonas urbana e rural do município de Rio Branco, Acre. A DRC foi definida pela taxa de filtração glomerular (TFG) < 60 ml/min/1,73 m², estimada pela CKD-EPI, e presença de albuminúria > 29 mg/g. Medidas de associação foram estimadas por regressão logística, com grau de confiança de 95%. A prevalência geral de DRC foi de 6,2%. A presença de DRC foi maior entre as mulheres, naqueles com 40 a 59 anos, de cor da pele não-branca, com menor escolaridade e entre os sedentários. Houve diferenças estatisticamente significativas na distribuição segundo a presença de DRC nas variáveis hipertensão arterial, diabetes e internação nos últimos 12 meses. A DRC entre os adultos esteve associada ao sexo feminino (OR: 2,41; IC95%: 1,14-5,12), diabetes (OR: 4,67; IC95%: 1,28-17,03) e hipertensão arterial (OR: 1,98; IC95%: 1,16-3,37). A DRC apresenta alta prevalência e está associada às doenças crônicas, evidenciando a necessidade de medidas em saúde pública para detecção precoce e prevenção da sua progressão.

Abstract The scope of this study was to establish the prevalence of CKD and associated factors among young adults (18-59 years of age) from Rio Branco in the State of Acre. It involved a population-based survey conducted in 2014, in the urban and rural areas of the municipality and CKD was defined as the glomerular filtration rate (GFR) < 60ml/min/1.73m², estimated by the CKD-EPI, and the presence of albuminuria > 29 mg/g. Association measures were estimated by logistic regression, with a confidence level of 95%. The overall prevalence of CKD was 6.2%. The presence of CKD was higher among women, aged 40 to 59 years, with non-white skin color, with lower schooling, and of sedentary disposition. There were statistically significant differences in the distribution according to the presence of CKD in the hypertension, diabetes and hospitalization variables over the past 12 months. CKD among adults was associated with the female sex (OR: 2.41, 95%CI: 1.14-5.12), diabetes (OR: 4.67, 95%CI: 1.28-17.03) and arterial hypertension (OR: 1.98; 95%CI: 1.16-3.37). CKD reveals a high prevalence and is associated with chronic diseases, calling for the need for public health measures for early detection and prevention of its progression.