Urgent-Start Peritoneal Dialysis: Brazilian Experience.

INTRODUCTION: Unplanned peritoneal dialysis (PD) is an important option for chronic kidney disease (CKD) patients requiring kidney replacement therapy urgently as it offers the convenience of home-based therapy. The objective of this study was to assess the Brazilian urgent-start PD program in three different dialysis centers where there is shortage of hemodialysis (HD) beds. METHODS: This prospective, multicentric cohort study included incident patients with stage 5 CKD and no permanent vascular access established who started urgent PD between July 2014 and July 2020 in three different hospitals. Urgent-start PD was defined as initiation of treatment up to 72 h after catheter placement. Patients were followed up from catheter insertion and assessed according to mechanical and infectious complications related to PD, patients, and technique survival. RESULTS: Over 6 years, 370 patients were included in all three study centers. Mean patient age was 57.8 ± 16.32 years. Diabetic kidney disease was the main underlying condition (35.1%) and uremia was the main cause for dialysis indication (81.1%). Concerning complications related to PD, 24.3% had mechanical complications, 27.3% had peritonitis, 28.01% had technique failure, and 17.8% died. On logistic regression, hospitalization (p = 0.003) and exit site infection (p = 0.002) were identified as predictors of peritonitis, while mechanical complications (p = 0.004) and peritonitis (p < 0.001) were identified as predictors of technique failure and switching to HD. Age (p < 0.001), hospitalization (p = 0.012), and bacteremia (p = 0.021) were observed to predict death. The number of patients on PD increased at least 140% in all three participating centers. CONCLUSION: PD is a feasible option for patients starting dialysis in an unplanned manner and may be a useful tool for reducing shortage of HD beds.

Assitência de enfermagem a gestante no HRAC/USP / Nursing care to pregnant women at HrAc/UsP

Objetivos: Os objetivos deste estudo são identificar e caracterizar as principais reações emocionais, as frequências absolutas e relativas e os domínios dos diagnósticos de enfermagem de gestantes e familiares mediante o impacto do nascimento de um filho com fissura labiopalatina, defeito congênito comum caracterizado por aberturas anatômicas anormais de lábio e de palato. Métodos: A partir de abordagem qualiquantitativa e pesquisa descritiva, realizaram-se entrevistas semi-estruturadas com 18 gestantes atendidas no Hospital Craniofaciais da Universidade de São Paulo no período de outubro de 2008 a abril de 2009...

Objective: The objectives of this study are to identify and characterize the major emotional reactions, the absolute and relative frequencies and domains of nursing diagnoses to pregnant women and families through the impact of the birth of a child with cleft lip and palate, congenital defect characterized by common abnormal anatomic openings lip and palate. Method: From qualitative and quantitative approach and descriptive research, there were semi-structured interviews with 18 women at the Hospital of Rehabilitation and Craniofacial Anomalies, University of São Paulo from October 2008 to April 2009...