Dietitians' practices in dialysis units in Brazil: nutritional assessment and intervention / Práticas de nutricionistas em unidades de diálise no Brasil: avaliação e intervenção nutricionais

ABSTRACT Introduction: The importance of dietitians in dialysis units is indisputable and mandatory in Brazil, but little is known about the practices adopted by these professionals. Objective: To know practices adopted in routine nutritional care, focusing on nutritional assessment tools and treatment strategies for people at risk or diagnosed with malnutrition. Methodology: Electronic questionnaire disseminated on social media and messaging applications. It included questions that covered dietitians' demographic and occupational profile characteristics and of the dialysis unit, use and frequency of nutritional assessment tools, nutritional intervention strategies in cases of risk or diagnosis of malnutrition, prescription and access to oral supplements. Results: Twenty four percent of the Brazilian dialysis units (n = 207) responded electronically. The most used nutritional assessment tools with or without a pre-established frequency were dietary surveys (96%) and Subjective Global Assessment (83%). The strategies in cases of risk or presence of malnutrition used most frequently (almost always/always) were instructions to increase energy and protein intake from foods (97%), and increasing the frequency of visits (88%). The frequency of prescribing commercial supplements with standard and specialized formulas was quite similar. The availability of dietary supplements by the public healthcare system to patients varied between regions. Conclusion: Most dietitians use various nutritional assessment tools and intervention strategies in cases of risk or malnutrition; however, the frequency of use of such tools and strategies varied substantially.

Resumo Introdução: A importância da atuação do nutricionista em unidades de diálise é indiscutível e obrigatória no Brasil, porém pouco sabemos sobre as práticas adotadas por esses profissionais. Objetivo: Conhecer práticas adotadas na rotina dos atendimentos nutricionais, com foco nas ferramentas de avaliação nutricional e nas estratégias de tratamento das pessoas com risco ou diagnóstico de desnutrição. Metodologia: Questionário eletrônico divulgado em mídias sociais e aplicativos de mensagens. Incluiu questões que abrangiam características do perfil demográfico e ocupacional do profissional e da unidade de diálise, utilização e frequência de ferramentas de avaliação nutricional, estratégias de intervenção nutricional em casos de risco ou diagnóstico de desnutrição e prescrição e acesso a suplementos alimentares orais. Resultados: Foram recebidos eletronicamente o equivalente a 24% das unidades de diálise brasileiras (n = 207). As ferramentas de avaliação nutricional mais utilizadas com ou sem frequência pré-estabelecida foram inquéritos dietéticos (96%) e Avaliação Global Subjetiva (83%). As estratégias em casos de risco ou presença de desnutrição utilizadas com mais frequência (quase sempre/sempre) foram a orientação de incremento energético e proteico por meio de alimentos (97%) e o aumento da periodicidade das visitas (88%). A frequência de prescrição de suplemento industrializado de fórmula padrão e especializada foi bastante semelhante. A disponibilização de suplementos alimentares pelo Sistema Único de Saúde aos pacientes variou entre as regiões. Conclusão: A maior parte dos nutricionistas utiliza diversas ferramentas de avaliação nutricional e estratégias de intervenção em casos de risco ou desnutrição, porém a frequência de utilização de tais ferramentas e estratégias foi bastante variada.

Brazilian Dialysis Survey 2022 / Censo Brasileiro de Diálise 2022

Abstract Introduction: The Brazilian Dialysis Survey (BDS) is an annual national survey about patients on chronic dialysis that contributes to health policies. Objective: To report the 2022 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). Methods: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire that included clinical and epidemiological aspects of patients on chronic dialysis, dialysis therapy data, and dialysis center characteristics. Results: Overall, 28% (n = 243) of the centers answered the questionnaire. In July 2022, the estimated total number of patients on dialysis was 153,831. The estimated prevalence and incidence rates of patients per million population (pmp) were 758 and 214, respectively. Of the prevalent patients, 95.3% were on hemodialysis (HD, 4.6% of these on hemodiafiltration) and 4.7% on peritoneal dialysis (PD). Only 1.3% of patients were not vaccinated against COVID-19. The prevalence of anemia (Hb < 10g/dL) was 27% and hyperphosphatemia (P > 5.5mg/dL) reached 30%. The estimated overall crude annual mortality rate was 17.1%. Conclusions: The absolute number and prevalence rate of patients on chronic dialysis continue to increase. A growing number of patients were receiving hemodiafiltration. The mortality rate decreased, probably due to the end of COVID-19 pandemic. The conclusions were drawn in the context of relatively low voluntary participation, which imposed methodological limitations on our estimates.

Resumo Introdução: O Censo Brasileiro de Diálise (CBD) é uma pesquisa nacional anual sobre pacientes em diálise crônica que contribui para as políticas de saúde. Objetivo: Informar os dados epidemiológicos de 2022 do CBD da Sociedade Brasileira de Nefrologia (SBN). Métodos: Foi realizada uma pesquisa em centros brasileiros de diálise por meio de um questionário online que incluiu aspectos clínicos e epidemiológicos de pacientes em diálise crônica, dados da terapia dialítica e características do centro de diálise. Resultados: No total, 28% (n = 243) dos centros de diálise ativos cadastrados na SBN responderam ao questionário. Em julho de 2022, o número total estimado de pacientes em diálise era de 153.831. As taxas estimadas de prevalência e incidência de pacientes por milhão (ppm) de habitantes foram 758 e 214, respectivamente. Dos pacientes prevalentes, 95,3% estavam em hemodiálise (HD; 4,6% desses em hemodiafiltração) e 4,7% em diálise peritoneal (DP). Apenas 1,3% dos pacientes não foram vacinados contra a COVID-19. A prevalência de anemia (Hb < 10g/dL) foi de 27% e de hiperfosfatemia (P > 5,5mg/dL) alcançou 30%. A taxa bruta total anual de mortalidade estimada foi de 17,1%. Conclusões: O número absoluto e a taxa de prevalência de pacientes em diálise crônica continuam a aumentar. Um número crescente de pacientes estava em hemodiafiltração. A taxa de mortalidade diminuiu, provavelmente devido ao fim da pandemia da COVID-19. As conclusões foram de um contexto de participação voluntária relativamente baixa, o que impõe limitações metodológicas às nossas estimativas.

Comparison of 1-year survival between patients initiating chronic hemodialysis under public and private health insurance: register-based data analysis from Brazil.

PURPOSE: Brazil has one of the world's highest numbers of patients on hemodialysis (HD). Most dialysis centers are private and perform HD for patients with private and public health insurance. We compared 1-year survival between patients initiating chronic HD with public and private health insurance. METHODS: This is an HD register-based retrospective cohort. Adult patients starting HD from January 2011 to December 2021 were included. Survival analysis was stratified according to the period entered in the HD register. Multivariate Cox regression focused on 1-year survival differences between private and public patients. RESULTS: In the final sample (n = 5114), 68.5% of participants had public and 31.3% to private health insurance, with overall 1-year survival of 92.8% and 89.9%, respectively (p = 0.002). Crude analysis showed a slightly higher survival rate among patients with public health insurance than those with private health insurance (91 vs. 87%, p = 0.030) in the first period (2019-21). However, the adjusted hazard ratio (HR) did not remain significantly higher for patients with private health insurance compared to those with public health insurance (HR = 1.07; 95% CI 0.80-1.41; p = 0.651), even after propensity score matching of the groups by several baseline features. CONCLUSION: Brazilian chronic HD patients funded by either private health plans or the public system have a similar 1-year mortality risk after controlling for several sociodemographic and clinical parameters.

Occupational risks associated with chronic kidney disease of non-traditional origin (CKDnt) in Brazil: it is time to dig deeper into a neglected problem.

In the past decades, an epidemic of chronic kidney disease (CKD) has been associated with environmental and occupational factors (heat stress from high workloads in hot temperatures and exposure to chemicals, such as pesticides and metals), which has been termed CKD of non-traditional origin (CKDnt). This descriptive review aims to present recent evidence about heat stress, pesticides, and metals as possible causes of CKDnt and provide an overview of the related Brazilian regulation, enforcement, and health surveillance strategies. Brazilian workers are commonly exposed to extreme heat conditions and other CKDnt risk factors, including increasing exposure to pesticides and metals. Furthermore, there is a lack of adequate regulation (and enforcement), public policies, and strategies to protect the kidney health of workers, considering the main risk factors. CKDnt is likely to be a significant cause of CKD in Brazil, since CKD's etiology is unknown in many patients and several conditions for its development are present in the country. Further epidemiological studies may be conducted to explore causal associations and estimate the impact of heat, pesticides, and metals on CKDnt in Brazil. Moreover, public policies should prioritize reducing workers´ exposure and promoting their health and safety.

Dietitians' practices in dialysis units in Brazil: nutritional assessment and intervention.

INTRODUCTION: The importance of dietitians in dialysis units is indisputable and mandatory in Brazil, but little is known about the practices adopted by these professionals. OBJECTIVE: To know practices adopted in routine nutritional care, focusing on nutritional assessment tools and treatment strategies for people at risk or diagnosed with malnutrition. METHODOLOGY: Electronic questionnaire disseminated on social media and messaging applications. It included questions that covered dietitians' demographic and occupational profile characteristics and of the dialysis unit, use and frequency of nutritional assessment tools, nutritional intervention strategies in cases of risk or diagnosis of malnutrition, prescription and access to oral supplements. RESULTS: Twenty four percent of the Brazilian dialysis units (n = 207) responded electronically. The most used nutritional assessment tools with or without a pre-established frequency were dietary surveys (96%) and Subjective Global Assessment (83%). The strategies in cases of risk or presence of malnutrition used most frequently (almost always/always) were instructions to increase energy and protein intake from foods (97%), and increasing the frequency of visits (88%). The frequency of prescribing commercial supplements with standard and specialized formulas was quite similar. The availability of dietary supplements by the public healthcare system to patients varied between regions. CONCLUSION: Most dietitians use various nutritional assessment tools and intervention strategies in cases of risk or malnutrition; however, the frequency of use of such tools and strategies varied substantially.

Demographic and occupational profile of dietitians working in dialysis centers in Brazil / Perfil demográfico e ocupacional de nutricionistas que atuam em unidades de diálise no Brasil

ABSTRACT Introduction: In 2004, the Ministry of Health stipulated that dialysis centers were required to have at least one dietitian on their staff. However, the regulation did not include recommendations regarding the number of dietitians or the workload based on the number of patients assisted. Objective: To describe the demographic and occupational profiles of dietitians working in dialysis centers in Brazil. Methodology: An electronic questionnaire was disseminated in social media and messaging apps with questions about the demographic and occupational profile of dietitians working in dialysis centers and matters related to patient care. Results: A total of 207 questionnaires were answered, covering 24% of the dialysis centers in Brazil. More than half of the dietitians (58%) had worked for more than five years in dialysis centers, and 83% reported additional training in Nephrology. The median (interquartile range) number of patients per monthly working hour was 1.6 (1.0-2.3). Considering all dialysis centers, 64% of the patients were seen at least once a month. Differences in demographic/occupational profiles and patient care were associated with workload, the main source of dialysis funding, and Brazilian geographical region. Conclusion: Most dietitians were experienced and trained in Nephrology. Substantial variability was found in the number of patients per dietitian workload, and proportion of patients receiving monthly nutritional care. Further studies are needed to discuss the demands of dietitians, dialysis centers, and patients.

RESUMO Introdução: Em 2004, o Ministério da Saúde estabeleceu que cada serviço de diálise deve ter no mínimo um nutricionista vinculado a ele. Porém, a regulamentação não incluiu recomendações em relação ao número de profissionais ou à carga horária de acordo com o número de pacientes assistidos. Objetivo: Conhecer o perfil e as práticas de nutricionistas que atuam em unidades de diálise brasileiras. Metodologia: O questionário eletrônico divulgado em mídias sociais e aplicativos de mensagens incluiu questões que abrangiam características do perfil demográfico e ocupacional do profissional e da unidade de diálise, além de perguntas relacionadas ao atendimento dos pacientes. Resultados: Foram recebidos eletronicamente 207 questionários, o equivalente a 24% das unidades de diálise brasileiras. Mais da metade dos nutricionistas (58%) atuava havia mais de cinco anos em unidades de diálise e 83% referiram formação complementar na área da Nefrologia. A mediana (interquartis) do número de pacientes por hora mensal de trabalho foi 1,6 (1,0-2,3). Considerando todas as unidades, o percentual de pacientes atendidos mensalmente foi correspondente a 64%. Diferenças no perfil e nas práticas foram encontradas de acordo com a carga horária, principal fonte financiadora da unidade de diálise e região demográfica brasileira. Conclusão: A maioria dos nutricionistas tem boa experiência e formação na área. Foi encontrada uma grande variabilidade em relação ao número de pacientes por carga horária do profissional e do percentual de indivíduos que recebiam atendimento nutricional mensal. São necessárias investigações que avaliem questões relacionadas tanto às demandas dos profissionais quanto às das unidades contratantes e dos pacientes.

Sex-specific differences in a large cohort of Brazilian incident dialysis patients over 12 years: A retrospective study.

OBJECTIVE: Sex-specific differences in the epidemiology of chronic kidney disease, such as higher prevalence of women on pre-dialysis and men on chronic dialysis treatment, have been reported worldwide. In this regard, data from non-high-income countries are scarce. We aimed to compare the demographic, clinical, and dialysis characteristics of incident dialysis patients, both men and women, in a large cohort of Brazilian patients over a 12-year period. METHODS: This was a multicentric retrospective cohort study coordinated by the Brazilian Society of Nephrology. The study included all adult incident dialysis patients in the Brazilian Dialysis Registry from January 2011 to December 2022. The variables studied encompassed age, skin color, education, CKD etiology, predialysis nephrologist care, dialysis characteristics, and geographic region. Additionally, the sample was analyzed for each of the three 4-year periods over the 12 years of data collection. RESULTS: A total of 24,632 incident dialysis patients were included. Men were 59.1% of the dialysis population, remaining stable over the three 4-year periods. Besides other differences, women started dialysis younger (58.5 ± 16.2 years vs 59.5 ± 14.4 years; p < 0.001), had a lower educational level (less than 8 years at school: 54% vs 44%; p < 0.001), received more predialysis nephrologist care (46.2% vs 44.2%; p = 0.04), and had a higher prevalence of peritoneal dialysis (4.4% vs 3.5%; p = 0.03). CONCLUSION: We consistently observed a higher prevalence of men on dialysis and differences in demographic, clinical, and dialysis characteristics. The underlying reasons for these sex differences still necessitate further clarification.

Demographic and occupational profile of dietitians working in dialysis centers in Brazil.

INTRODUCTION: In 2004, the Ministry of Health stipulated that dialysis centers were required to have at least one dietitian on their staff. However, the regulation did not include recommendations regarding the number of dietitians or the workload based on the number of patients assisted. OBJECTIVE: To describe the demographic and occupational profiles of dietitians working in dialysis centers in Brazil. METHODOLOGY: An electronic questionnaire was disseminated in social media and messaging apps with questions about the demographic and occupational profile of dietitians working in dialysis centers and matters related to patient care. RESULTS: A total of 207 questionnaires were answered, covering 24% of the dialysis centers in Brazil. More than half of the dietitians (58%) had worked for more than five years in dialysis centers, and 83% reported additional training in Nephrology. The median (interquartile range) number of patients per monthly working hour was 1.6 (1.0-2.3). Considering all dialysis centers, 64% of the patients were seen at least once a month. Differences in demographic/occupational profiles and patient care were associated with workload, the main source of dialysis funding, and Brazilian geographical region. CONCLUSION: Most dietitians were experienced and trained in Nephrology. Substantial variability was found in the number of patients per dietitian workload, and proportion of patients receiving monthly nutritional care. Further studies are needed to discuss the demands of dietitians, dialysis centers, and patients.

Brazilian Dialysis Survey 2022.

INTRODUCTION: The Brazilian Dialysis Survey (BDS) is an annual national survey about patients on chronic dialysis that contributes to health policies. OBJECTIVE: To report the 2022 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). METHODS: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire that included clinical and epidemiological aspects of patients on chronic dialysis, dialysis therapy data, and dialysis center characteristics. RESULTS: Overall, 28% (n = 243) of the centers answered the questionnaire. In July 2022, the estimated total number of patients on dialysis was 153,831. The estimated prevalence and incidence rates of patients per million population (pmp) were 758 and 214, respectively. Of the prevalent patients, 95.3% were on hemodialysis (HD, 4.6% of these on hemodiafiltration) and 4.7% on peritoneal dialysis (PD). Only 1.3% of patients were not vaccinated against COVID-19. The prevalence of anemia (Hb < 10g/dL) was 27% and hyperphosphatemia (P > 5.5mg/dL) reached 30%. The estimated overall crude annual mortality rate was 17.1%. CONCLUSIONS: The absolute number and prevalence rate of patients on chronic dialysis continue to increase. A growing number of patients were receiving hemodiafiltration. The mortality rate decreased, probably due to the end of COVID-19 pandemic. The conclusions were drawn in the context of relatively low voluntary participation, which imposed methodological limitations on our estimates.

Hemodialysis in Brazil: differences across geographic regions regarding demographics, laboratory parameters and drug prescription / Hemodiálise no Brasil: diferenças entre regiões geográficas quanto a dados demográficos, parâmetros laboratoriais e prescrição de medicamentos

ABSTRACT Introduction: Brazil has a vast territory divided into five geographic regions with important differences in sociodemographic indices. We aimed to present and compare socio-demographic characteristics, biochemical results, and drug prescription of patients on chronic hemodialysis (HD) treatment in the five geographic regions. Methods: We evaluated data from the Brazilian Dialysis Registry of all adult patients undergoing chronic HD in 2021. Variables included sociodemographic characteristics, serum levels of phosphate, calcium, and albumin, hemoglobin, urea reduction rate, and prescription of phosphate binders, erythropoietin, and intravenous iron. Data from the North and Northeast regions were combined into one group. Results: A total of 13,792 patients (57.9 ± 16.0 years old, 58.5% male, median HD vintage of 31 (11-66) months) from 73 dialysis centers were analyzed. Regional distribution was 59.5% in the Southeast; 21.7% in the South; 5.9% in the Midwest; and 12.9% in the North/Northeast. Sociodemographic features, biochemical results, and medication prescriptions differed across regions. The prevalence of elderly patients was lower in the Midwest and North/Northeast. The South region had the highest prevalence of hyperphosphatemia (41.2%) and urea reduction rate <65% (24.8%), while anemia and hypoalbuminemia were more prevalent in the Southeast, 32.7% and 11.6%, respectively. Conclusion: We found differences in socio-demographics, clinical features, and drug prescriptions across Brazilian geographic regions. Some findings reflect the socio-demographic diversity of the country, while others deserve further elucidation.

Introdução: O Brasil possui um vasto território dividido em cinco regiões geográficas com importantes diferenças nos índices sociodemográficos. Nosso objetivo foi apresentar e comparar características sociodemográficas, resultados bioquímicos e prescrição de medicamentos de pacientes em tratamento de hemodiálise crônica (HD) nas cinco regiões geográficas. Métodos: Avaliamos os dados do Registro Brasileiro de Diálise de todos os pacientes adultos submetidos à HD crônica em 2021. As variáveis incluíram características sociodemográficas, níveis séricos de fosfato, cálcio e albumina, hemoglobina, taxa de redução de ureia e prescrição de quelantes de fosfato, eritropoietina e ferro intravenoso. Os dados das regiões Norte e Nordeste foram combinados em um único grupo. Resultados: Foi analisado um total de 13.792 pacientes (57,9 ± 16,0 anos, 58,5% do sexo masculino, mediana de tempo de HD de 31 (11-66) meses) de 73 centros de diálise. A distribuição regional foi de 59,5% dos pacientes provenientes do Sudeste; 21,7% do Sul; 5,9% do Centro-Oeste; e 12,9% do Norte/Nordeste. As características sociodemográficas, os resultados bioquímicos e as prescrições de medicamentos diferiram entre as regiões. A prevalência de pacientes idosos foi menor nas regiões Centro-Oeste e Norte/Nordeste. A região Sul apresentou a maior prevalência de hiperfosfatemia (41,2%) e taxa de redução de ureia < 65% (24,8%), enquanto a anemia e a hipoalbuminemia foram mais prevalentes no Sudeste, 32,7% e 11,6%, respectivamente. Conclusão: Encontramos diferenças nos dados sociodemográficos, nas características clínicas e prescrições de medicamentos nas regiões geográficas brasileiras. Alguns achados refletem a diversidade sociodemográfica do país, enquanto outros demandam maiores esclarecimentos.

Ultraprocessed foods and chronic kidney disease-double trouble.

High energy intake combined with low physical activity generates positive energy balance, which, when maintained, favours obesity, a highly prevalent morbidity linked to development of non-communicable chronic diseases, including chronic kidney disease (CKD). Among many factors contributing to disproportionately high energy intakes, and thereby to the obesity epidemic, the type and degree of food processing play an important role. Ultraprocessed foods (UPFs) are industrialized and quite often high-energy-dense products with added sugar, salt, unhealthy fats and food additives formulated to be palatable or hyperpalatable. UPFs can trigger an addictive eating behaviour and is typically characterized by an increase in energy intake. Furthermore, high consumption of UPFs, a hallmark of a Western diet, results in diets with poor quality. A high UPF intake is associated with higher risk for CKD. In addition, UPF consumption by patients with CKD is likely to predispose and/or to exacerbate uraemic metabolic derangements, such as insulin resistance, metabolic acidosis, hypertension, dysbiosis, hyperkalaemia and hyperphosphatemia. Global sales of UPFs per capita increased in all continents in recent decades. This is an important factor responsible for the nutrition transition, with home-made meals being replaced by ready-to-eat products. In this review we discuss the potential risk of UPFs in activating hedonic eating and their main implications for health, especially for kidney health and metabolic complications of CKD. We also present various aspects of consequences of UPFs on planetary health and discuss future directions for research to bring awareness of the harms of UPFs within the CKD scenario.

Hemodialysis in Brazil: differences across geographic regions regarding demographics, laboratory parameters and drug prescription.

INTRODUCTION: Brazil has a vast territory divided into five geographic regions with important differences in sociodemographic indices. We aimed to present and compare socio-demographic characteristics, biochemical results, and drug prescription of patients on chronic hemodialysis (HD) treatment in the five geographic regions. METHODS: We evaluated data from the Brazilian Dialysis Registry of all adult patients undergoing chronic HD in 2021. Variables included sociodemographic characteristics, serum levels of phosphate, calcium, and albumin, hemoglobin, urea reduction rate, and prescription of phosphate binders, erythropoietin, and intravenous iron. Data from the North and Northeast regions were combined into one group. RESULTS: A total of 13,792 patients (57.9 ± 16.0 years old, 58.5% male, median HD vintage of 31 (11-66) months) from 73 dialysis centers were analyzed. Regional distribution was 59.5% in the Southeast; 21.7% in the South; 5.9% in the Midwest; and 12.9% in the North/Northeast. Sociodemographic features, biochemical results, and medication prescriptions differed across regions. The prevalence of elderly patients was lower in the Midwest and North/Northeast. The South region had the highest prevalence of hyperphosphatemia (41.2%) and urea reduction rate <65% (24.8%), while anemia and hypoalbuminemia were more prevalent in the Southeast, 32.7% and 11.6%, respectively. CONCLUSION: We found differences in socio-demographics, clinical features, and drug prescriptions across Brazilian geographic regions. Some findings reflect the socio-demographic diversity of the country, while others deserve further elucidation.

Increase in peritoneal dialysis-related hospitalization rates after telemedicine implementation during the COVID-19 pandemic / Aumento de las tasas de hospitalización relacionadas con la diálisis peritoneal después de la implementación de telemedicina durante la pandemia de la COVID-19

Introduction and objectives: To minimize our peritoneal dialysis (PD) population exposure to coronavirus disease (COVID-19), in April 2020 we developed and implemented a telemedicine program. In this investigation, we aimed to compare the hospitalization rates and metabolic disorders in patients undergoing PD 6 months before and after the COVID-19 pandemic and telemedicine implementation. Materials and methods: This single-center retrospective analysis included all active prevalent patients undergoing PD from April 2020. Dialysis records were reviewed to obtain clinical, demographic, laboratory, appointment, and hospitalization data. We compared hospitalization rates (total, non-PD-related, and PD-related), hospitalization-associated factors, and metabolic disorders (hemoglobin, serum potassium, and serum phosphate) 6 months before and after the pandemic. Results: Our sample comprised 103 participants. During the pre-pandemic and post-pandemic periods, there were 13 and 27 hospital admissions, respectively. The total hospitalization incident rate ratio (IRR) was 2.48 (95% confidence interval [CI], 1.29–4.75). PD-related hospitalizations increased from 3 to 15 episodes (IRR=7.25 [95% CI, 2.11–24.78]). In the pre-pandemic period, the educational level was lower in participants hospitalised due to PD-related issues than in participants not hospitalised. In the post-pandemic period, only sex distribution differed between patients not hospitalised and those hospitalised due to non-PD-related issues. Only serum potassium levels changed significantly in the post-pandemic period (4.79±0.48 vs. 4.93±0.54mg/dL; P<0.01). (AU)

Introducción y objetivos: Para minimizar la exposición de nuestra población de diálisis peritoneal (DP) a la enfermedad por coronavirus (COVID-19), en abril del 2020 desarrollamos e implementamos un programa de telemedicina. En esta investigación, nuestro objetivo fue comparar las tasas de hospitalización y los trastornos metabólicos en pacientes sometidos a DP 6 meses antes y después de la pandemia de COVID-19 y la implementación de la telemedicina. Materiales y métodos: Este análisis retrospectivo de un solo centro incluyó a todos los pacientes prevalentes activos sometidos a DP desde abril del 2020. Se revisaron los registros de diálisis para obtener datos clínicos, demográficos, de laboratorio, de citas y de hospitalización. Comparamos las tasas de hospitalización (total, no relacionada con la DP y relacionada con la DP), los factores asociados a la hospitalización y los trastornos metabólicos (hemoglobina, potasio sérico y fosfato sérico) 6 meses antes y después de la pandemia. Resultados: Nuestra muestra fue compuesta por 103 participantes. Durante los períodos prepandémico y pospandémico, hubo 13 y 27 ingresos hospitalarios, respectivamente. La razón de la tasa de incidentes de hospitalización (TIR) total fue de 2,48 (intervalo de confianza [IC] del 95%, 1,29-4,75). Las hospitalizaciones relacionadas con la DP aumentaron de 3 a 15 episodios (TIR=7,25 [IC del 95%, 2,11-24,78]). En el período prepandémico, el nivel educativo fue más bajo en los participantes hospitalizados debido a problemas relacionados con la DP que en los participantes no hospitalizados. En el período posterior a la pandemia, solo la distribución por sexo difirió entre los pacientes no hospitalizados y los hospitalizados debido a problemas no relacionados con la DP. Solo los niveles de potasio sérico cambiaron significativamente en el período pospandémico (4.79±0.48 frente a 4.93±0.54 mg/dL; P<0.01). (AU)

High prevalence of hyperkalemia in Brazilian chronic dialysis patients and differences across geographic regions / Prevalência elevada de hipercalemia em pacientes brasileiros em diálise crônica e diferenças entre as regiões geográficas

Abstract Introduction: Hyperkalemia is a common multifactorial condition of people on chronic dialysis and is associated with mortality. We aimed to inform and discuss the prevalence of hyperkalemia in a large population of chronic dialysis patients in Brazil and its geographic regions. Methods: Prevalence of hyperkalemia (serum potassium ≥6.0 mEq/L) was assessed in the Brazilian Dialysis Survey (BDS) in July 2019, an online survey of voluntary participation in which all dialysis centers registered at the Brazilian Society of Nephrology were invited. Results: Approximately one-third (n=263 of 805) of the Brazilian dialysis clinics participated. The prevalence of hyperkalemia in the whole population was 16.1% (n=7,457 of 46,193; 95%CI=15.8-16.5%,), and varied from 12.1% in the North to 18.7% in the Northeast. Conclusion: We found a high prevalence of hyperkalemia in a large Brazilian chronic dialysis population. A nationwide investigation of risk factors, treatment options, and whether this high prevalence contributes to dialysis mortality is warranted.

Resumo Introdução: A hipercalemia é uma condição multifatorial comum em pessoas em diálise crônica e está associada à mortalidade. Nosso objetivo foi informar e discutir a prevalência de hipercalemia em uma grande população de pacientes em diálise crônica no Brasil e diferenças entre as regiões geográficas. Métodos: A prevalência de hipercalemia (potássio sérico ≥6,0 mEq/L) foi avaliada por meio do Censo Brasileiro de Diálise (CBD) em Julho de 2019, uma pesquisa online de participação voluntária na qual foram convidados todos os centros de diálise registrados na Sociedade Brasileira de Nefrologia. Resultados: Aproximadamente um terço (n=263 de 805) das clínicas de diálise brasileiras participaram. A prevalência de hipercalemia na população total foi de 16,1% (n=7.457 de 46.193; IC95%=15,8-16,5%), e variou de 12,1% no Norte a 18,7% no Nordeste. Conclusão: Encontramos uma elevada prevalência de hipercalemia em umagrande população brasileira em diálise crônica. É necessária uma investigação nacional dos fatores de risco, opções de tratamento e se esta alta prevalência contribui para a mortalidade desta população.

Characteristics and 1-year survival of incident patients on chronic peritoneal dialysis compared with hemodialysis:a large 11-year cohort study.

PURPOSE: Few studies have evaluated patients' characteristics and survival by dialysis modality in Brazil. We evaluated changes in dialysis modality and its survival in the country. METHODS: This is a retrospective database of a cohort with incident chronic dialysis patients from Brazil. Patients' characteristics and one-year multivariate survival risk were assessed considering dialysis modality from 2011 to 2016 and 2017 to 2021. Survival analysis was also performed on a reduced sample after adjustment using propensity score matching. RESULTS: Of the 8295 dialysis patients, 5.3% were on peritoneal dialysis (PD) and 94.7% on hemodialysis (HD). PD patients had higher BMI, schooling and the prevalence of elective dialysis starting in the first period than those on HD. In the second period, PD patients were predominantly women, non-white, from the Southeast region, and funded by the public health system, having more frequent elective dialysis starting and predialysis nephrologist follow-ups than those on HD. There was no difference in mortality comparing PD and HD (HR 0.67, 95% CI 0.39-2.42; and HR 1.17, 95% CI 0.63-2.16; first and second period, respectively). This non-significantly different survival between both dialysis methods was also found in the reduced matched sample. Higher age and non-elective dialysis initiation were associated with higher mortality. In the second period, the lack of predialysis nephrologist follow-up and living in the Southeast region increased the mortality risk. CONCLUSION: Some sociodemographic factors have changed according to dialysis modality over the last decade in Brazil. The one-year survival of the two dialysis methods was comparable.

High prevalence of hyperkalemia in Brazilian chronic dialysis patients and differences across geographic regions.

INTRODUCTION: Hyperkalemia is a common multifactorial condition of people on chronic dialysis and is associated with mortality. We aimed to inform and discuss the prevalence of hyperkalemia in a large population of chronic dialysis patients in Brazil and its geographic regions. METHODS: Prevalence of hyperkalemia (serum potassium ≥6.0 mEq/L) was assessed in the Brazilian Dialysis Survey (BDS) in July 2019, an online survey of voluntary participation in which all dialysis centers registered at the Brazilian Society of Nephrology were invited. RESULTS: Approximately one-third (n=263 of 805) of the Brazilian dialysis clinics participated. The prevalence of hyperkalemia in the whole population was 16.1% (n=7,457 of 46,193; 95%CI=15.8-16.5%,), and varied from 12.1% in the North to 18.7% in the Northeast. CONCLUSION: We found a high prevalence of hyperkalemia in a large Brazilian chronic dialysis population. A nationwide investigation of risk factors, treatment options, and whether this high prevalence contributes to dialysis mortality is warranted.

Increase in peritoneal dialysis-related hospitalization rates after telemedicine implementation during the COVID-19 pandemic.

Introduction and objectives: To minimize our peritoneal dialysis (PD) population exposure to coronavirus disease (COVID-19), in April 2020 we developed and implemented a telemedicine program. In this investigation, we aimed to compare the hospitalization rates and metabolic disorders in patients undergoing PD 6 months before and after the COVID-19 pandemic and telemedicine implementation. Materials and methods: This single-center retrospective analysis included all active prevalent patients undergoing PD from April 2020. Dialysis records were reviewed to obtain clinical, demographic, laboratory, appointment, and hospitalization data. We compared hospitalization rates (total, non-PD-related, and PD-related), hospitalization-associated factors, and metabolic disorders (hemoglobin, serum potassium, and serum phosphate) 6 months before and after the pandemic. Results: Our sample comprised 103 participants. During the pre-pandemic and post-pandemic periods, there were 13 and 27 hospital admissions, respectively. The total hospitalization incident rate ratio (IRR) was 2.48 (95% confidence interval [CI], 1.29-4.75). PD-related hospitalizations increased from 3 to 15 episodes (IRR = 7.25 [95% CI, 2.11-24.78]). In the pre-pandemic period, the educational level was lower in participants hospitalised due to PD-related issues than in participants not hospitalised. In the post-pandemic period, only sex distribution differed between patients not hospitalised and those hospitalised due to non-PD-related issues. Only serum potassium levels changed significantly in the post-pandemic period (4.79 ± 0.48 vs. 4.93 ± 0.54 mg/dL; P < 0.01). Conclusion: This study showed a significant increase in hospitalization rates after the COVID-19 pandemic period and telemedicine implementation, mainly due to PD-related infectious causes. Strategies to improve distance monitoring assistance are needed for the PD population.

Introducción y objetivos: Para minimizar la exposición de nuestra población de diálisis peritoneal (DP) a la enfermedad por coronavirus (COVID-19), en abril del 2020 desarrollamos e implementamos un programa de telemedicina. En esta investigación, nuestro objetivo fue comparar las tasas de hospitalización y los trastornos metabólicos en pacientes sometidos a DP 6 meses antes y después de la pandemia de COVID-19 y la implementación de la telemedicina. Materiales y métodos: Este análisis retrospectivo de un solo centro incluyó a todos los pacientes prevalentes activos sometidos a DP desde abril del 2020. Se revisaron los registros de diálisis para obtener datos clínicos, demográficos, de laboratorio, de citas y de hospitalización. Comparamos las tasas de hospitalización (total, no relacionada con la DP y relacionada con la DP), los factores asociados a la hospitalización y los trastornos metabólicos (hemoglobina, potasio sérico y fosfato sérico) 6 meses antes y después de la pandemia. Resultados: Nuestra muestra fue compuesta por 103 participantes. Durante los períodos prepandémico y pospandémico, hubo 13 y 27 ingresos hospitalarios, respectivamente. La razón de la tasa de incidentes de hospitalización (TIR) total fue de 2,48 (intervalo de confianza [IC] del 95%, 1,29-4,75). Las hospitalizaciones relacionadas con la DP aumentaron de 3 a 15 episodios (TIR = 7,25 [IC del 95%, 2,11-24,78]). En el período prepandémico, el nivel educativo fue más bajo en los participantes hospitalizados debido a problemas relacionados con la DP que en los participantes no hospitalizados. En el período posterior a la pandemia, solo la distribución por sexo difirió entre los pacientes no hospitalizados y los hospitalizados debido a problemas no relacionados con la DP. Solo los niveles de potasio sérico cambiaron significativamente en el período pospandémico (4.79 ± 0.48 frente a 4.93 ± 0.54 mg/dL; P < 0.01). Conclusión: Este estudio mostró un aumento significativo en las tasas de hospitalización después del período pandémico de COVID-19 y la implementación de la telemedicina, principalmente debido a causas infecciosas relacionadas con la DP. Se necesitan estrategias para mejorar la asistencia de monitoreo a distancia para la población con DP.

Prevalence and Determinants of Predialysis Dietitian Follow-Up: Results From the Brazilian Dialysis Registry.

OBJECTIVE: We aimed to evaluate the prevalence and sociodemographic determinants of predialysis dietitian follow-up in a large cohort of Brazilian dialysis patients. METHODS: We retrospectively evaluated data from all incident adult dialysis patients included in the Brazilian Dialysis Registry from January 2011 to September 2021. Predialysis dietitian follow-up was classified as present when a period more than 6 months of dietitian care was reported. Gender, age, skin color, education, body mass index, chronic kidney disease etiology, first chronic dialysis program, healthcare provider, and geographic regions were tested in logistic regression models. RESULTS: Ten thousand three hundred and eighty two patients met the inclusion criteria and 1,254 (12.1%) reported predialysis dietitian follow-up, most of them referred by a nephrologist (94.2%). The independent determinants of dietitian follow-up were older age, white skin color, higher education level, not having diabetes, living in North/Northeast and South (compared to Southeast), and having a nonpublic healthcare provider. When considered only patients under a predialysis care of a nephrologist, higher education, hemodialysis as the first dialysis modality, and living in the North/Northeast and South regions (compared with Southeast) were associated with dietitian follow-up. CONCLUSION: Predialysis dietitian follow-up for more than 6 months in a country where the public health system is the main dialysis provider is still very low. The nephrologist is pivotal for referral to dietitians but socioeconomic factors also seem to play a role in this regard.