The cross-talk between the kidney and the gut: implications for chronic kidney diseaseThe cross-talk between the kidney and the gut: implications for chronic kidney disease

In recent decades, special attention has been given to the potential association between the gut ecosystem and chronic diseases. Several features and complications of chronic kidney disease (CKD) may induce an unbalanced gut environment, leading to unfavorable consequences for a patient's health. The first section of this review is dedicated to a description of some aspects of gut microbiota and intestinal barrier physiology. The following section explores the impact of CKD on the gut ecosystem and intestinal barrier, particularly the association with uremic toxins, inflammation, and immunodeficiency. Finally, the review describes the state of the art of potential therapies with prebiotics, probiotics, and synbiotics employed to modulate the gut environment and to reduce the generation of colon-derived uremic toxins in CKD.

Morbimortality study of infection in patients undergoing different types of dialysis in a renal replacement therapy center

INTRODUCTION: Renal replacement therapy is the treatment of end-stage chronic kidney disease and can be performed through dialysis catheters, arteriovenous fistulas/grafts, and peritoneal dialysis. Patients are usually immunocompromised and exposed to invasive procedures, leading to high rates of infection and increased mortality. OBJECTIVES: To compare the prevalence of infection and related deaths, as well as the sensitivity profile of the putative bacteria in patients treated with peritoneal dialysis, arteriovenous fistula hemodialysis and catheter hemodialysis. METHODS: This is case-control study. Six hundred forty-four patients undergoing renal replacement therapy were selected. Patients were divided into three groups according to the modality of dialysis treatment: peritoneal dialysis (126 patients), arteriovenous fistula hemodialysis (326 patients), and catheter hemodialysis (192 patients). RESULTS: One hundred sixteen patients (18.01%) developed infection. There was a higher incidence of infection in the peritoneal dialysis group (44 patients; 34.92%; OR: 3.32; CI 95% = 2.13-5.17; p = 0.0001). In the catheter hemodialysis group, 48 patients (25%) had infection (OR: 1.88; CI 95%: 1.24-2.85; p = 0.0035). In the arteriovenous fistula hemodialysis group, 24 patients (7.36%) developed infection (OR: 0.19; CI 95%: 0.12-0.31; p = 0.0001). Five patients (4.31%) died due to infection (four in the peritoneal dialysis group and one in the catheter hemodialysis group). There were no deaths due to infection in the arteriovenous fistula hemodialysis group. CONCLUSIONS: Peritoneal dialysis is the treatment with greater risk of infection and mortality, followed by catheter hemodialysis. The lowest risk of infection and mortality was observed in arteriovenous fistula hemodialysis group. .

Effect of non-surgical periodontal treatment on the subgingival microbiota of patients with chronic kidney disease

This study investigated the effect of non-surgical periodontal therapy on the composition of subgingival microbiota of patients with chronic kidney disease (CKD). Sixteen CKD pre-dialysis individuals (CKD) and 14 individuals without clinical evidence of kidney disease (C) presenting chronic periodontitis were treated by scaling and root planing. Subgingival samples were collected from each patient and analyzed for their composition by checkerboard at baseline and 3 months post-therapy. Significant differences between groups at baseline were sought by the Mann-Whitney and χ² tests. Changes over time were examined by the Wilcoxon test. At baseline, the CKD group had significantly lower counts of E. faecalis compared to the C group (p < 0.05). After treatment, the levels of a greater number of species were reduced in the C group. Higher levels of A. israelii, C. rectus, F. periodonticum, P. micra, P. nigrescens, T. forsythia, N. mucosa, and S. anginosus (p < 0.05) were found in the CKD group compared to the C group. Also, non-responsive sites in CKD individuals harbored significantly higher levels of pathogenic species (T. forsythia, P. gingivalis, T. denticola, Fusobacterium spp., D. pneumosintes, E. faecalis and S. aureus; p < 0.05) than sites that responded to therapy, as well as non-responsive sites in the C group. The periodontitis-associated subgingival microbiota of CKD and systemically healthy individuals was similar in composition. However, high levels of pathogenic species persisted in the subgingival microbiota of patients with CKD after treatment.

Incidencia de helicobacter pylori en pacientes con insuficiencia renal cronica en diálisis / Incidence of helicobacte pylori in patients with chronic renal failure in dialysis

La infección crónica con helicobacter pylori (Hp) se ha asociado con enfermedad acidopéptica (EAP), la presentan 80 por ciento de pacientes con insuficiencia renal crónica (IRC) en diálisis (D). La urea es el metabolito preferido por el Hp; las concentraciones elevadas con las que cursan los pacientes con IRC; deben favorecer la alta incidencia del Hp. Se investigó la incidencia del Hp en pacientes con IRC en D y se comparó con pacientes con función renal normal y se describieron las alteraciones gastrointestinales. Se incluyeron en el estudio 120 pacientes: 60 pacientes con IRC en D y 60 pacientes con función renal normal; todos los pacientes presentaron enfermedad acidopéptica, a todos se les hizo endoscopía del tracto digestivo alto y toma de biopsia gástrica y duodenal. El diagnóstico de Hp se hizo por examen directo de la muestra por microscopía. 50 (83 por ciento) de los 60 pacientes con IRC en D tuvieron Hp, las alteraciones gastroduodenales más frecuente fueron: gastritis, duodenitis, erosiones gástricas y duodenales. En los pacientes con función renal normal 45 (75 por ciento) de los 60 tuvieron Hp. Las alteraciones gastrointestinales más frecuentes fueron: gastritis y duodenitis. La incidencia de Hp en pacientes con IRC en D fue discretamente más alta que en el grupo control, no significativa; las concentraciones más elevadas de urea en pacientes con IRC en D, no fueron un factor determinante en la incidencia del Hp.

Comparación de dos métodos de dosificación de gentamicina en pacientes con insuficiencia renal / Comparison of 2 determination methos of gentamicin in patients with renal insufficiency

Debido a la nefrotoxicidad de la gentamicina, se diseñó un estudio prospectivo y comparativo con el fin de determinar el esquema de dosificación más adecuado para prevenir el deterioro de la función renal en pacientes con insuficiencia renal y proceso infeccioso con germen sensible a gentamicina. Se aplicaron dosis de la droga de acuerdo con los esquemas de dosificación de Chan y Sarubbi. Se ingresaron pacientes hospitalizados mayores de 15 años, con diagnóstico de insuficiencia renal e infección de gérmenes sansibles a gentamicina. Se estudiaron 45 pacientes, los cuales fueron distribuidos en dos grupos; en el Grupo I se administró gentamicina de acuerdo con el esquema de Chan y en el Grupo II de acuerdo con el de Sarubbi. La depuración de creatinina al inicio y al final en el Grupo I fue de 38.75 ñ 17.7 y 36.8 ñ 16.3 ml/min, respectivamente, y para el Grupo II de 38.14 ñ 15.87 y 40.16 ñ 16.01, respectivamente, no habiendo significación estadística (p>0.5). Los niveles de Gentamicina durante el estudio no variaron por el esquema utilizado, en el Grupo I 3.53 ñ 0.63 y 4.12 ñ 0.59, en el Grupo II 3.45 ñ 0.7 y 4.22 ñ 0.61 µg/ml, respectivamente. Se concluye que los dos esquemas de dosificación utilizados son aptos para mantener niveles adecuados de gentamicina sin deterioro significativo de la función renal en pacientes con insuficiencia renal. La elección de uno de los esquemas evaluados dependerá del conocimiento del mismo y de las facilidades técnicas con que se cuente