High Self-Reported Prevalence of Kidney Stones in Trinidad and Tobago: Results of a Cross-Sectional Online Survey.

Introduction No data exist on the prevalence of kidney stone disease in Trinidad and Tobago. Local clinicians have noted that the disease is very common, and this study represents the first attempt to investigate the prevalence of urolithiasis in these islands. Objectives The objective is to estimate the prevalence of kidney stone disease in Trinidad and Tobago and to investigate the epidemiology of the disease. Methods An online survey using the online tool Survey Monkey was distributed among members of the public via instant messaging and social media. The survey captured data relating to the stone status and demographics of respondents. Results 1225 patients completed the survey of whom 46.5% were males and 53.5% were females. Respondents were equally distributed throughout the country. 16.74% of those surveyed indicated that they were currently affected by stones confirmed by imaging. Kidney stones were more common among Trinidadians of East Indian ancestry (20.6% vs 10.6%). Positive correlations were established between kidney stones and the presence of hypertension, diabetes, and gout. Persons with kidney stones were more likely to have a family member with the disease - 45.6% vs 31.4% among those without kidney stones. Conclusion This study demonstrates a high self-reported prevalence of kidney stones in Trinidad and Tobago.

Is hemodiafiltration superior to high-flow hemodialysis in reducing all-cause and cardiovascular mortality in kidney failure patients? A meta-analysis of randomized controlled trials.

INTRODUCTION: Hemodiafiltration (HDF) and high-flux hemodialysis (hf-HD) are different methods of kidney replacement therapy (KRT) used for the treatment of kidney failure patients. A debate has raged over the last decade about the survival benefit of patients with the use of HDF compared with hf-HD, but with divergent results from randomized controlled trials. Therefore, this study aimed to perform a meta-analysis to compare HDF and hf-HD regarding all-cause and cardiovascular mortality. METHODS: PubMed and Cochrane databases were searched until July 19, 2023, for randomized clinical trials comparing HDF and hf-HD in patients on maintenance dialysis. A meta-analysis was performed using Stata 16.1, applying fixed or random effect models according to the heterogeneity between studies. FINDINGS: Of the 496 studies found, five met the inclusion criteria. Compared with the hf-HD group, the risk ratio (RR) for all-cause mortality with HDF use was 0.76 (95% CI: 0.67-0.88, I2 = 0%). HDF was associated with lower cardiovascular mortality, although the sensitivity analysis showed that the result differed between scenarios. Subgroup analysis showed lower all-cause mortality among patients without diabetes in the HDF group compared with hf-HD (RR 0.66, 95% CI: 0.51-0.81, I2 = 0%), but not in diabetic patients (RR = 0.89, 95% CI: 0.65-1.12, I2 = 0.0%). A subgroup analysis considering convection volumes was not performed, but the studies with the highest weight in the meta-analysis described convection volume as more than 20 L/session. DISCUSSION: More clinical studies considering critical risk factors, such as advanced age and preexisting cardiovascular disease, are needed to confirm the supremacy of HDF over hf-HD on the survival of patients treated by these two forms of kidney replacement therapy.

Psychometrically validated questionnaires to measure the effects and benefits/barriers to physical exercise in hemodialysis patients: a systematic review.

PURPOSE: To provide a critical assessment, summarize, and synthesize the evidence from studies using psychometrically validated questionnaires to assess the effects and benefits/barriers of physical exercise in hemodialysis patients. METHODS: The search was performed on six electronic databases. It was conducted following the PRISMA statement and the PICO framework. The methodological quality was assessed using the MMAT. Were used the quality criteria for psychometric properties developed by Terwee et al. RESULTS: Overall, 70 studies were included, and 39 questionnaires identified, evaluating 13 outcomes. The quality of the psychometric properties of the questionnaires was not always described; only 13 presented positive ratings on > =6/9 properties. The most assessed measure was criterion validity, and the least assessed criteria was responsiveness. The most outcome measured by these questionnaires was quality of life using SF-36, followed by psychological health using the BDI. The DPEBBS was the only instrument identified that assessed the benefits and barriers of exercise. CONCLUSION: Quality of life and depression were the most frequent outcomes. Other measures contemplating physical, mental, cognitive performance, and especially of the perceptions benefits and barriers to exercise should be further investigated. We have clearly identified the need for more studies evaluating psychometric measures that have not been tested satisfactorily or hardly been tested at all.

Reliable instruments, valid and structurally adequate were identified to support clinicians and researchers in measuring important outcomes in hemodialysis patients.Quality of life and depression were the most frequent outcomes with good research instruments.A gap was identified related to instruments that assess physical, mental, cognitive performance, and perceptions of benefits and barriers to exercise in hemodialysis patients.

Comparison of palonosetron and ondansetron in preventing postoperative nausea and vomiting in renal transplantation recipients: a randomized clinical trial

Abstract Background: End-stage renal diseases patients have a high risk of postoperative nausea and vomiting (PONV), which is multifactorial and need acute attention after renal transplantation for a successful outcome in term of an uneventful postoperative period. The study was done to compare the efficacy of palonosetron and ondansetron in preventing early and late-onset PONV in live donor renal transplantation recipients (LDRT). Methods: The prospective randomized double-blinded study was done on 112 consecutive patients planned for live donor renal transplantation. Patients of both sexes in the age group of 18-60 years were randomly divided into two groups: Group O (Ondansetron) and Group P (Palonosetron) with 56 patients in each group by computer-generated randomization. The study drug was administered intravenously (IV) slowly over 30 seconds, one hour before extubation. Postoperatively, the patients were accessed for PONV at 6, 24, and 72 hours using the Visual Analogue Scale (VAS) nausea score and PONV intensity scale. Results: The incidence of PONV in the study was found to be 30.35%. There was significant difference in incidence of PONV between Group P and Group O at 6 hours (12.5% vs. 32.1%, p = 0.013) and 72 hours (1.8% vs. 33.9%, p < 0.001), but insignificant difference at 24 hours (1.8% vs. 10.7%, p = 0.113). VAS-nausea score was significantly lower in Group P as compared to Group O at a time point of 24 hours (45.54 ± 12.64 vs. 51.96 ± 14.70, p = 0.015) and 72 hours (39.11 ± 10.32 vs. 45.7 ± 15.12, p = 0.015). Conclusion: Palonosetron is clinically superior to ondansetron in preventing early and delayed onset postoperative nausea and vomiting in live-related renal transplant recipients.

Effects of nutritional supplementation stabilizing muscle mass loss in older patients on hemodiafiltration.

BACKGROUND & AIMS: Malnutrition is common in older individuals with end-stage renal disease on maintenance dialysis. Whether nutritional supplementation may improve skeletal muscle mass (SMM) and survival rate in this population is uncertain. We aimed to analyze the effect of a year of nutritional supplementation on muscle mass and survival rate in older patients on hemodiafiltration. METHODS: In this observational study, older patients (≥65 years old) on maintenance hemodiafiltration were selected to receive nutritional counselling + nutritional supplementation (N = 85, Supp+) or nutritional counselling alone (N = 47, Supp-) and followed for 1 year. The outcomes were a change in SMM and sarcopenia diagnosis. The secondary outcome was 1-year mortality rate. Nutritional parameters included calf circumference, body mass index, anthropometric measurements, subjective global assessment, and handgrip strength (HGS). Data were evaluated using GLM for repeated measures with adjustment for covariates (age and diabetes). RESULTS: Malnutrition was found in 50.8% of patients. At baseline, patients from the Supp+ group were older and had worse nutritional parameters including hand grip strength, calf circumference, anthropometric findings and sarcopenia (all p values < 0.05). During the follow-up, there was no significant change in sarcopenia (from 50.8% to 58.3%, p = 0.108), and there was a more pronounced decrease in the SMM index in the Supp-group (p = 0.049), with a significant intervention interaction (p = 0.030). Twenty deaths occurred, 7 (35%) in the Supp- and 13 (65%) in the Supp+ group (p = 0.540). SMM index (relative risk 0.90, p = 0.030) and age (relative risk 1.07, p = 0.046) were independently associated with higher mortality rates. CONCLUSION: Nutritional supplementation in older and malnourished individuals undergoing hemodiafiltration mitigates the loss of the SMM index and benefits survival rate.

Renal transplant waiting list mortality in COVID era: is it advisable to halt transplant activity?

INTRODUCTION: Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). Since March 2020, transplant activity in Mexico has been affected due to the COVID-19 pandemic. OBJECTIVE: The aim of the study was to determine the impact on mortality of patients on the waiting list (WL) for cadaveric donor kidney transplantation in a referral hospital in Yucatán, due to suspension of activities due to the pandemic. MATERIAL AND METHODS: Patients over 18 years of age on the waiting list for kidney transplantation at this hospital. In the event of a patient's death, the cause was investigated, especially if it was associated with COVID-19. A two-tailed p ≤ 0.05 was considered significant in all analyzes. RESULTS: The odds ratio (OR) of death from COVID-19 in a patient with ESRD in the WL in 2020 was OR = 5.04 (95% CI: 1.65-7.14, p = 0.023). The OR of dying with ESRD in the WL with a delay in the follow-up visits was OR = 6.59 (95% CI: 2.7-16.28, p = 0.008). CONCLUSION: The probability of death of a patient with ESRD with delayed follow-up visits and transplant retention is statistically higher than the probability of death from COVID-19.

INTRODUCCIÓN: El trasplante renal es el tratamiento de elección de la enfermedad renal en etapa terminal (ERT). Desde marzo de 2020, la actividad de trasplantes en México se ha visto afectada debido a la pandemia de COVID-19. OBJETIVO: Determinar el impacto en la mortalidad de pacientes en lista de espera (LE) para trasplante renal de donante cadavérico en un hospital de referencia en Yucatán, por suspensión de actividades debido a la pandemia. MATERIAL Y MÉTODOS: Pacientes > 18 años en LE para trasplante renal en este hospital. En caso de muerte de un paciente, se investigó la causa, especialmente si estaba asociada a COVID-19. Un valor de p de dos colas ≤ 0.05 se consideró significativo en todos los análisis. RESULTADOS: La razón de probabilidad de muerte por COVID-19 en un paciente con ERT en la LE en 2020 fue OR = 5.04 (IC 95%: 1.65-7.14, p = 0.023). La razón de probabilidad de morir con ERT en la LE con retraso en las consultas de seguimiento fue de OR = 6.59 (IC 95%: 2.7-16.28, p = 0.008). CONCLUSIÓN: La probabilidad de muerte de un paciente con ERT en la LE con retraso en las consultas de seguimiento y retención del trasplante es estadísticamente más alta que la probabilidad de muerte por COVID-19.

Bleeding during tooth extraction in patients with chronic kidney disease: A cross-sectional pilot study.

OBJECTIVE: This work measures the intra-operative bleeding in end-stage renal disease patients and assesses whether laboratory coagulation tests and nitrogenous compounds are related to a higher bleeding risk. METHODS: Laboratory tests were performed on the day of surgery and some patients with thrombocytopenia and values above the normal levels of international normalised ratio (INR), thrombin time (TT) and activated partial thromboplastin time (aPTT) were identified. RESULTS: Haemostatic time ranged from 2 to 35 min (mean of 8.51 min) after suture. Bleeding volume ranged from 0.02 to 67.06 mL (mean of 4.38 mL) and the bleeding volume per minute ranged from 0.05 to 2.10 mL/min (median of 0.6 mL/min). Only seven patients (16.27%) had abnormal bleeding (more than 0.6 mL/min). Spearman's coefficient showed weak correlations between bleeding volume (mL/min) and serum urea (r = 0.226), TT (r = 0.227), plasma urea (r = 0.148) and creatinine (r = 146), as well as very weak correlations with all other variables (r < 0.140) such as age, haemodialysis time, glycaemia, glycated haemoglobin, platelets, INR, aPTT and fibrinogen. CONCLUSION: It was not possible to associate any laboratory test or nitrogenous compounds present in the blood and saliva with an increased bleeding.

End-stage renal disease due to retroperitoneal fibrosis in neurofibromatosis type I.

Retroperitoneal fibrosis (RF) commonly leads to renal impairment due to compression of ureters, and around 8% of patients eventually progress to end-stage renal disease (ESRD). We present a case of RF in a 61-year-old female patient with neurofibromatosis type 1 (NF1) who developed ESRD. She presented with a postrenal acute kidney injury, being initially treated with an ureteral catheter. A magnetic resonance imaging of the abdomen showed parietal thickening of the right ureter, and she underwent right ureter reimplantation through bladder flap and psoas hitch. There was an extensive area of fibrosis and inflammation over the right ureter. Biopsy disclosed nonspecific fibrosis, which was consistent with RF. Although the procedure was successful, she developed ESRD. We review atypical presentations of RF and causes of renal injury in NF1. RF should be considered a possible cause of chronic kidney disease in patients with NF1, perhaps due to an unknown underlying mechanism.

Understanding the Burden of Kidney Failure in Trinidad and Tobago: A Review of the Epidemiological Data From a Regional Center.

Objective The aim of this study was to determine the incidence of new patients requiring renal replacement therapy and to gather data on sex, age, ethnicity, mortality, and causes of kidney failure in Trinidad and Tobago in comparison with the rest of the world. Method Electronic data were gathered for new patients initiating dialysis between January 1, 2016, and December 31, 2017, including the date of dialysis initiation, age, gender, ethnicity, diagnosis, dialysis access and modality, and outcome at three months and the end of the year. The data were analyzed using simple descriptive statistics via Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). Results Over a two-year period, 265 new patients underwent renal replacement therapy, of which 51.7% were 50-69 years of age, 53.9% were male, 46% were female, 67.9% were Afro-Trinidadian, and 38.1% had a combination of diabetes mellitus and hypertension as the cause of kidney failure. The incidence rates of treated end-stage renal disease (ESRD) globally in 2016 and 2017 were 306 and 224 per million population, respectively, and mortality for both years was 32% and 32.1%, respectively. Conclusion Our study showed that Trinidad and Tobago has one of the highest incidences of patients initiating renal replacement therapy and mortality rates.

Optimizing peritoneal dialysis initiation: A comparative cohort study of catheter placement methods for shortening break-in periods.

INTRODUCTION: Peritoneal dialysis (PD) guidelines recommend a 14-day break-in period after catheter placement, yet this period could be shortened with new insertion techniques. METHODS: We conducted a prospective cohort study to compare percutaneous vs. surgical catheter insertion in a newly established PD program. The break-in period was intentionally shortened to <24 h to start PD almost immediately. RESULTS: We included 223 subjects who underwent percutaneous (34%) or surgical (66%) catheter placement. Compared to the surgical group, the percutaneous group had a higher proportion of early dialysis initiation within 24 h (97% vs. 8%, p < 0.001), similar successful initiation rates (87% vs. 92%, p = 0.34), and shorter lengths of stay (12 [9-18] vs. 18 [14-22] days, p < 0.001). Percutaneous insertion increased the likelihood of successful PD initiation within 24 h (OR 74, 95% CI 31-182), without increasing major complications. CONCLUSION: Percutaneous placement could represent a cost-effective and efficient technique to shorten break-in periods.

Analysis of clinical outcomes of arteriovenous fistula for hemodialysis access in a Mexican elderly population.

OBJECTIVE: The increased survival rates of end-stage renal disease (ESRD) patients have impacted directly in the proportion of elderly patients requiring a reliable hemodialysis (HD) access; this group clearly demands an individualized approach. We aim to analyze maturation and patency rates of arteriovenous fistulas (AVF) in elderly patients. METHODS: This was retrospective review of a database of patients that underwent AVF creation in our institution. The maturation and patency rates were analyzed divided in groups based on age (equal and greater of 65 years, and patients under 65 years). Patency rates were compared using Kaplan-Meier analysis. RESULTS: Twenty patients ≥ 65 years old (mean 73, SD ± 5.4) were analyzed. The overall maturation rate in this group was 75% compared to 84.1% (p = 0.33) in the younger group (mean age 48 years, SD ± 17). The primary patency at 6 and 12 months for the ≥ 65 years group was 93% and 86%, respectively, compared with 85% and 81% for the younger group (p = 0.77). CONCLUSION: Autogenous AVF remains the preferred and durable option for elderly patients. We found no difference in terms of maturation and patency rates compared to younger patients. Standardized protocols are needed to optimally select vascular accesses.

ANTECEDENTES: El aumento de las tasas de supervivencia en los pacientes con enfermedad renal terminal ha impactado en los pacientes con acceso para hemodiálisis. OBJETIVO: Analizar las tasas de maduración y permeabilidad de las fístulas arteriovenosas en pacientes adultos mayores. MÉTODO: Estudio retrospectivo en el que se incluyeron pacientes a los que se realizó fístula arteriovenosa. Las tasas de maduración y permeabilidad se analizaron divididas en grupos según la edad (≥ 65 y < 65 años). Las tasas de permeabilidad se compararon mediante análisis de Kaplan-Meier. RESULTADOS: Se analizaron 20 pacientes ≥ 65 años. La tasa de maduración global en este grupo fue del 75%, frente al 84.1% (p = 0.33) en el grupo más joven. La permeabilidad primaria a los 6 y 12 meses para el grupo ≥ 65 años fue del 93% y el 86%, respectivamente, en comparación con el 85% y el 81% en el grupo más joven (p = 0.77). CONCLUSIONES: La fístula arteriovenosa autógena sigue siendo la opción preferida y duradera para los pacientes de edad avanzada. No encontramos diferencias en cuanto a las tasas de maduración y permeabilidad en comparación con los pacientes más jóvenes.

Association Between Protocols of the Sit-to-Stand Test and Lower Limb Muscle Force Output in Patients on Hemodialysis and Subjects Without Chronic Kidney Disease.

OBJECTIVE: To evaluate the association of three protocols of the sit-to-stand (STS) test with muscle force output of knee extension (KE) and knee flexion (KF) in patients on hemodialysis and subjects without chronic kidney disease. METHODS: This cross-sectional study included a hemodialysis group [n = 60, 59.5 (16.8) years, 55% female] and a control group [n = 60, 43.0 (11.8) years, 50% female]. The assessments were performed in 2 days, and the participants were submitted to three protocols of STS test (5-repetition STS, 10-repetition STS and 30-s STS) or muscle force output of the KE and KF evaluation by handheld dynamometer based on randomization. RESULTS: The hemodialysis group presented reduced muscle force output of the KE and KF, a longer time to perform the 5 STS and 10 STS tests, and a lower number of repetitions in the 30-s STS test. The three STS tests were associated with muscle force output of the KE in the hemodialysis group, in which the 10-repetition STS test showed the best association (R2 = 0.47; adjusted R2 = 0.42). However, the only association between the STS test and muscle force output of the KE in the control group was found in the 10-repetition STS test (R2 = 0.20; adjusted R2 = 0.13). CONCLUSIONS: The three protocols of STS tests were associated with muscle force output of the KE in patients on hemodialysis. However, the 10-repetition STS test was the best protocol to estimate the quadriceps muscle torque in these patients.

High Plasma Levels of Fibroblast Growth Factor 23 Are Associated with Increased Risk of COVID-19 in End-Stage Renal Disease Patients on Hemodialysis: Results of a Prospective Cohort.

End-stage renal disease (ESRD) patients are a population with high rates of COVID-19 and mortality. These patients present a low response to anti-SARS-CoV-2 immunization, which is associated with immune dysfunction. ESRD patients also present high plasma titers of Fibroblast Growth Factor 23 (FGF23), a protein hormone that reduces immune response in vivo and in vitro. Increased FGF23 levels associate with higher infection-related hospitalizations and adverse infectious outcomes. Thus, we evaluated whether ESRD patients with high FGF23 titers have an increased rate of SARS-CoV-2 infection. METHODS: We performed a prospective cohort of ESRD patients in hemodialysis who had measurements of plasma intact FGF23 in 2019. We determined COVID-19 infections, hospitalizations, and mortality between January 2020 and December 2021. RESULTS: We evaluated 243 patients. Age: 60.4 ± 10.8 years. Female: 120 (49.3%), diabetes: 110 (45.2%). During follow-up, 45 patients developed COVID-19 (18.5%), 35 patients were hospitalized, and 12 patients died (mortality rate: 26.6%). We found that patients with higher FGF23 levels (defined as equal or above median) had a higher rate of SARS-CoV-2 infection versus those with lower levels (18.8% versus 9.9%; Hazard ratio: 1.92 [1.03-3.56], p = 0.039). Multivariate analysis showed that increased plasma FGF23 was independently associated with SARS-CoV-2 infection and severe COVID-19. DISCUSSION: Our results suggest that high plasma FGF23 levels are a risk factor for developing COVID-19 in ESRD patients. These data support the potential immunosuppressive effects of high circulating FGF23 as a factor implicated in the association with worse clinical outcomes. Further data are needed to confirm this hypothesis.

Antimicrobial Photodynamic Therapy in the Nasal Decolonization of Maintenance Hemodialysis Patients: A Pilot Randomized Trial.

RATIONALE & OBJECTIVE: Infections are an important cause of mortality among patients receiving maintenance hemodialysis. Staphylococcus aureus is a frequent etiological agent, and previous nasal colonization is a risk factor for infection. Repeated antimicrobial decolonization reduces infection in this population but can induce antibiotic resistance. We compared photodynamic therapy, a promising bactericidal treatment that does not induce resistance, to mupirocin treatment among nasal carriers of S aureus. STUDY DESIGN: Randomized controlled pilot study. SETTING & PARTICIPANTS: 34 patients receiving maintenance hemodialysis who had nasal carriage of S aureus. INTERVENTIONS: Patients were randomly assigned to decolonization with a single application of photodynamic therapy (wavelength of 660nm, 400mW/cm2, 300 seconds, methylene blue 0.01%) or with a topical mupirocin regimen (twice a day for 5 days). OUTCOME: Nasal swabs were collected at time 0 (when the carrier state was identified), directly after treatment completion, 1 month after treatment, and 3 months after treatment. Bacterial isolates were subjected to proteomic analysis to identify the species present, and antimicrobial susceptibility was characterized. RESULTS: All 17 participants randomized to photodynamic therapy and 13 of 17 (77%) randomized to mupirocin were adherent to treatment. Directly after treatment was completed, 12 participants receiving photodynamic therapy (71%) and 13 participants treated with mupirocin (77%) had cultures that were negative for S aureus (risk ratio, 0.92 [95% CI, 0.61-1.38]; P=0.9). Of the patients who had negative cultures directly after completion of photodynamic therapy, 67% were recolonized within 3 months. There were no adverse events in the photodynamic therapy group. LIMITATIONS: Testing was restricted to assessing nasal colonization; infectious complications were not assessed. CONCLUSIONS: Photodynamic therapy is a feasible approach to treating nasal carriage of S aureus. Future larger studies should be conducted to determine whether photodynamic therapy is equivalent to the standard of care with mupirocin. FUNDING: Government grant (National Council for Scientific and Technological Development process 3146682020-9). TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT04047914.

Glittre activities of daily living test is reliable and valid in hemodialysis patients.

PURPOSE: To examine the validity, and the relative and absolute within-day reliability of the TGlittre in chronic kidney disease patients undergoing hemodialysis (HD). MATERIALS AND METHODS: Thirty HD patients (52 ± 12 years) undertook the TGlittre twice on a single day, in a cross-sectional design. For validation purposes, participants TGlittre performance and accelerometry-based physical activity were correlated. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were determined to assess within-day reliability. RESULTS: There was a moderate correlation between TGlittre performance and moderate to vigorous physical activity (r= -0.587; p= 0.001). The relative reliability of the test showed an ICC of 0.96. For the absolute reliability, the SEM was 13.05 s (0.22 min), and the MDC was 36.17 s (0.60 min). CONCLUSIONS: TGlittre performance is associated with moderate to vigorous physical activity in HD patients, highlighting that those with higher levels of physical activity are likely to perform better on the TGlittre. Additionally, TGlittre shows a good to excellent intra-rater reliability and a low SEM. An MDC value was established.Implications for rehabilitationPatients on hemodialysis have a low physical capacity and often struggle to simply complete their physical activities of daily living.The TGlittre is a tool for assessing functional capacity through completion of multiple physical activities of daily living and can be easily applied in a clinical setting.TGlittre is a valid test that elicit reliable physiological, hemodynamic, and physical performance responses in HD patients.

Tratamiento trombolítico de rescate en paciente con fístula arteriovenosa para hemodiálisis trombosada / Rescue thrombolytic treatment in patients with arteriovenous fistula for thrombosed hemodialysis

Introducción: La hemodiálisis continúa siendo la modalidad de terapia de reemplazo renal prevalente en el mundo. La disfunción de la fístula arteriovenosa para hemodiálisis tiene efectos negativos en el paciente y su calidad de vida, por lo que el acceso vascular funcional se necesita para un adecuado tratamiento de hemodiálisis en pacientes con enfermedad renal terminal. El mayor inconveniente del acceso vascular resulta su alta incidencia de oclusión trombótica, causada por la estenosis, la cual se inicia por lesiones hiperplásicas de la capa intimal del vaso. Una de las modalidades de tratamiento a nivel internacional es la trombólisis del acceso vascular trombosado de menos de 24 horas de evolución. Objetivo: Exponer los resultados obtenidos con la aplicación de la trombólisis percutánea del acceso vascular para hemodiálisis trombosado en paciente con enfermedad renal terminal. Presentación del caso: Paciente masculino de 52 años, con diagnóstico de trombosis aguda del acceso vascular para hemodiálisis por enfermedad renal terminal, de 5 días de evolución, con deterioro de su estado de salud por encontrarse subdializado y urémico, con agotamiento del acceso vascular global para hemodiálisis. Se utilizó el tratamiento fibrinolítico directo del acceso vascular percutáneo a 100 mil UI/hora de Heberquinasa® en 10 horas, con recuperación del latido, thrill y repermeabilización de la fístula para hemodiálisis. Conclusiones: El tratamiento fibrinolítico con Heberquinasa® permitió la recuperación del paciente con trombosis aguda del acceso vascular para hemodiálisis. Se evitaron complicaciones asociadas a la subdiálisis y/o colocación de catéter central, y se incorporó al paciente a su programa de hemodiálisis, con garantías para su calidad de vida(AU)

Introduction: Hemodialysis continues to be the prevalent renal replacement therapy modality in the world. Arteriovenous fistula dysfunction for hemodialysis has negative effects on the patients and their quality of life, so functional vascular access is needed for adequate hemodialysis treatment in patients with end-stage renal disease. The greatest drawback of vascular access is its high incidence of thrombotic occlusion, caused by stenosis, which is initiated by hyperplastic lesions of the intimate layer of the vessel. One of the treatment modalities at the international level is the thrombolysis of the thrombosed vascular access of less than 24 hours of evolution. Objective: To present the results obtained with the application of percutaneous thrombolysis of vascular access for thrombosed hemodialysis in patients with end-stage renal disease. Case presentation: Male patient of 52 years, with diagnosis of acute thrombosis of vascular access for hemodialysis due to end-stage renal disease, 5 days of evolution, with deterioration of his health state due to being sub-dialized and uremic, with exhaustion of the global vascular access for hemodialysis. Direct fibrinolytic treatment of percutaneous vascular access at 100 thousand IU/hour of Heberkinase® was used in 10 hours, with recovery of the heartbeat, thrill and repermeabilisation of the fistula for hemodialysis. Conclusions: Fibrinolytic treatment with Heberkinase® allowed the recovery of the patient with acute thrombosis from the vascular access for hemodialysis. Complications associated with sub-dialysis and/or central catheter placement were avoided, and the patient was incorporated into their hemodialysis program, with guarantees for their quality of life(AU)

Aplicabilidad de modelos predictivos de falla renal en enfermedad renal crónica: una revisión de alcance / Usability of predictive models of kidney failure in chronic kidney disease: a scoping review

Resumen Introducción: la identificación de los pacientes con mayor riesgo de progresar a falla renal es fundamental para la planeación del tratamiento en la enfermedad renal crónica, pero no ha podido llevarse a cabo consistentemente. Los modelos de predicción podrían ser una herramienta útil, sin embargo, su usabilidad en la Enfermedad Renal Crónica es limitada hasta ahora y no se comprenden muy bien las barreras y limitaciones. Métodos: se desarrolló una revisión de alcance de la literatura disponible sobre modelos predictivos de falla renal o reglas de pronóstico en pacientes con Enfermedad Renal Crónica. Las búsquedas se realizaron sistemáticamente en Cochrane, Pubmed y Embase. Se realizó una revisión ciega e independiente por dos evaluadores para identificar estudios que informaran sobre el desarrollo, la validación o la evaluación del impacto de un modelo construido para predecir la progresión al estadio avanzado de la enfermedad renal crónica. Se realizó una evaluación crítica de la calidad de la evidencia proporcionada con el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Resultados: de 1279 artículos encontrados, fueron incluidos 19 estudios para la síntesis cualitativa final. La mayoría de los estudios eran primarios, con diseños observacionales retrospectivos y unos pocos correspondieron a revisiones sistemáticas. No se encontraron guías de práctica clínica. La síntesis cualitativa evidenció gran heterogeneidad en el desarrollo de los modelos, así como en el reporte de las medidas de desempeño global, la validez interna y la falta de validez externa en la mayoría de los estudios. La calificación de la evidencia arrojó una calidad global baja, con inconsistencia entre los estudios e importantes limitaciones metodológicas. Conclusiones: la mayoría de los modelos predictivos disponibles, no han sido adecuadamente validados y, por tanto, se consideran de uso limitado para evaluar el pronóstico individual del paciente con enfermedad renal crónica. Por lo tanto, se requieren esfuerzos adicionales para centrar el desarrollo e implementación de modelos predictivos en la validez externa y la usabilidad y disminuir la brecha entre la generación, la síntesis de evidencia y la toma de decisiones en el ámbito del cuidado del paciente.

Abstract Background: the identification of patients at higher risk of progressing to kidney failure is essential for treatment planning in chronic kidney disease, but it has not been possible to do this consistently. Predictive models could be a useful tool, however, their usability in chronic kidney disease is limited and the barriers and limitations are not well understood. Methods: a scoping review of the available literature on ESRD predictive models or prognostic rules in chronic kidney disease patients was developed. Searches were systematically executed on Cochrane, MEDLINE, and Embase. a blind and independent review was carried out by two evaluators to identify studies that reported on the development, validation, or impact assessment of a model constructed to predict the progression to an advanced stage of chronic kidney disease. A critical evaluation of the quality of the evidence provided with the GRADE system (Grading of Recommendations Assessment, Development and Evaluation) was made. Findings: of 1279 articles found, 19 studies were included for the final qualitative synthesis. Most of the studies were primary, with retrospective observational designs and a few corresponded to systematic reviews. No clinical practice guidelines were found. The qualitative synthesis showed high heterogeneity in the development of the models, as well as in the reporting of global performance measures, internal validity, and the lack of external validity in most of the studies. The evidence rating was of low overall quality, with inconsistency between studies and important methodological limitations. Conclusions: most of the available predictive models have not been adequately validated and, therefore, are of limited use to assess the individual prognosis of patients with chronic kidney disease. Therefore, additional efforts are required to focus the development and implementation of predictive models on external validity and usability and bridge the gap between generation, synthesis of evidence, and decision-making in the field of patient care.

Good Long-Term Prognosis of Lupus Nephritis in the High-Income Afro-Caribbean Population of Martinique with Free Access to Healthcare.

Lupus nephritis (LN) has been described as having worse survival and renal outcomes in African-descent patients than Caucasians. We aimed to provide long-term population-based data in an Afro-descendant cohort of LN with high income and easy and free access to specialized healthcare. STUDY DESIGN: We performed a retrospective population-based analysis using data from 2002-2015 of 1140 renal biopsies at the University Hospital of Martinique (French West Indies). All systemic lupus erythematosus patients with a diagnosis of LN followed for at least 12 months in Martinique or who died during this period were included. RESULTS: A total of 89 patients were included, of whom 68 (76.4%) had proliferative (class III or IV), 17 (19.1%) had membranous (class V), and 4 (4.5%) had class I or II lupus nephritis according to the ISN/RPS classification. At a mean follow-up of 118.3 months, 51.7% of patients were still in remission. The rates of end-stage renal disease were 13.5%, 19.1%, and 21.3% at 10, 15, and 20 years of follow-up, respectively, and mortality rates were 4.5%, 5.6%, and 7.9% at 10, 15, and 20 years of follow-up, respectively. CONCLUSIONS: The good survival of our Afro-descendant LN patients, similar to that observed in Caucasians, shades the burden of ethnicity but rather emphasizes and reinforces the importance of optimizing all modifiable factors associated with poor outcome, especially socioeconomics.

Factores de riesgo para falla de la técnica en diálisis peritoneal: estudio de cohorte retrospectivo

Contexto la falla de la técnica en diálisis peritoneal puede ocurrir de manera no planificada, afectando los costos en salud y la calidad de vida del paciente. Objetivo estimar la incidencia de falla de la técnica y mortalidad y determinar los factores de riesgo asociados con el tiempo a la falla de la técnica, por causas médicas en el primer año de la terapia de reemplazo renal. Metodología estudio de cohorte retrospectivo que incluyó 2192 pacientes incidentes en diálisis peritoneal, utilizando los registros de centros de terapia renal Baxter en Colombia, durante el periodo entre enero del 2016 y diciembre del 2017. Asimismo, se estimó la tasa de incidencia y la tasa de mortalidad y se usó el análisis de regresión de Cox multivariado para determinar los factores de riesgo para falla de la técnica. Resultados se estimó una tasa de incidencia de falla de la técnica de 8,8/100 personas/año. La tasa de mortalidad fue de 7,9/100 personas/año. El modelo de regresión de Cox multivariado mostró que los factores de riesgo fueron hipertensión arterial (HR: 1,59; IC 95 % 1,01-2,48) y género masculino (HR:1,62; IC 95 % 1,03-2,56) y los factores protectores fueron el Kt/V > 1,7 (HR: 0,41; IC 95 % 0,25-0,65) e incrementar 1 gr/dl la albúmina (HR: 0,61; IC 95 % 0,43-0,87). Conclusiones la tasa de incidencia de falla de la técnica en el primer año de diálisis peritoneal en Colombia fue baja y la disfunción mecánica fue la principal causa. Los factores de riesgo asociados con el tiempo a la falla de la técnica fueron hipertensión arterial y género masculino.

Background The technique failure in peritoneal dialysis can occur in an unplanned way, affecting health costs and the patient's quality of life. Purpose The aims of this study were to estimate the incidence of technique failure and mortality; and to determine the risk factors associated with time to failure of technique due to medical causes in the first year of renal replacement therapy. Methodology Retrospective cohort study that included 2192 incident patients on peritoneal dialysis using the records of Baxter renal therapy centers in Colombia, during the period January 2016 and December 2017. The incidence rate and mortality rate were estimated. Multivariate Cox regression analysis was used to determine risk factors for technique failure. Results An incidence rate of failure of the technique of 8.8/100 person-years was estimated. The mortality rate was 7.9/100 person-years. The multivariate Cox regression model showed as risk factors arterial hypertension (HR: 1.59; 95% CI 1.01-2.48) and male sex (HR: 1.62; 95% CI 1.03-2.56); and the protective factors were Kt / V> 1.7 (HR: 0.41; CI95% 0.25-0.65) and increase 1 gr / dl of albumin (HR: 0.61; CI95% 0.43-0.87). Conclusions The incidence rate of technique failure in the first year of peritoneal dialysis in Colombia was low and mechanical dysfunction was the main cause. The risk factors associated with time to failure of the technique were arterial hypertension and male gender.

Correlation between Angiotensin Serum Levels and Very-Low-Frequency Spectral Power of Heart Rate Variability during Hemodialysis.

Cardiovascular regulatory mechanisms that fail to compensate for ultrafiltration and cause hypovolemia during hemodialysis (HD) are not completely understood. This includes the interaction between the autonomic nervous system and the biochemistry that regulates blood pressure and modulates cardiac activity and vascular tone in response to hypovolemia in patients treated with HD. The objective was to evaluate the association of spectral indices of heart rate variability (HRV) with serum levels of angiotensin II, angiotensin 1-7, nitric oxide and total antioxidant capacity during HD. Electrocardiographic records were obtained from 20 patients during HD (3 h), from which HRV data and spectral power data in the very-low-frequency (VLF), low-frequency (LF) and high-frequency (HF) bands were generated. Three blood samples per patient were collected during HD (0.0, 1.5, 3.0 h) to determine the levels of biomarkers involved in the pressor response during HD. Angiotensin II had a positive correlation with VLF (r = 0.390) and with LF/HF (r = 0.359) and a negative correlation with LF (r = -0.262) and HF (r = -0.383). There were no significant correlations between HRV and the other biomarkers. These results suggest that during HD, VLF could reflect the serum levels of angiotensin II, which may be associated with the autonomic response to HD.