Safety and efficacy of HepaSphere 50-100 µm in the treatment of hepatocellular carcinoma.

AIM: To evaluate the effects of HepaSphere 50-100 µm (Merit Medical) as a doxorubicin carrier and embolization agent for the treatment of hepatocellular carcinoma (HCC). MATERIAL AND METHODS: A prospective analysis of 18 patients recruited from a national cancer center was conducted. This analysis evaluated the efficacy and safety of HepaSphere, as expressed by the treatment response rate (measured by the modified Response Evaluation Criteria in Solid Tumors, mRECIST) and by the prevalence of treatment-related adverse events, respectively. RESULTS: The cohort was predominantly male, with a mean age of 69 years. The objective response rate (complete + partial response) was 53.3%. The variable most likely to be associated with objective response was Barcelona Clinic Liver Cancer (BCLC) staging. The most prevalent adverse events were nausea, vomiting and abdominal pain. CONCLUSION: HepaSphere chemoembolization yielded a substantial objective response rate with an acceptable toxicity profile and should be considered an option for HCC treatment.

Brazilian Consensus on the Application of Thermal Ablation for Treatment of Thyroid Nodules: A Task Force Statement by the Brazilian Society of Interventional Radiology and Endovascular Surgery (SOBRICE), Brazilian Society of Head and Neck Surgery (SBCCP), and Brazilian Society of Endocrinology and Metabolism (SBEM).

There is increasing interest in ultrasound-guided ablation treatments for thyroid diseases, including benign and malignant ones. Surgeons, radiologists, and endocrinologists carry out these treatments, and various organizations within these specialties have recently released multiple international consensus statements and clinical practice standards. The aim of the present consensus statement is to provide guidance, cohesion, and standardization of best practices for thermal ablation procedures of thyroid nodules. The statement includes the indications for these procedures, preprocedural evaluations, technical aspects of the procedures, posttreatment care, follow-up, complications, and training recommendations. This document was written by a panel of specialists from the Brazilian Society of Interventional Radiology and Endovascular Surgery (SOBRICE), the Brazilian Society of Head and Neck Surgery (SBCCP), and the Brazilian Society of Endocrinology and Metabolism (SBEM). The statement does not aim to provide criteria for assessing the capability of specialists to perform the procedure. Instead, it aims to promote the standardization of best practices to reduce potential adverse outcomes. Additionally, it strives to enhance the delivery of high-quality care and the widespread adoption of these technologies on a national level. The recommendations collectively serve as a guidebook for applying best practices in thyroid ablation.

Gastrointestinal symptoms and nutritional status in women and men on maintenance hemodialysis.

OBJECTIVE: The main objective was to investigate whether the prevalences of nausea, vomiting, diarrhea, and reduced appetite varied by gender in maintenance hemodialysis (MHD) patients. We also evaluated whether these symptoms explain female-male difference in nutritional status. DESIGN: Cross section of baseline data of the Prospective Study of the Prognosis in Chronic Hemodialysis Patients. SETTING: Dialysis units in the city of Salvador, Brazil. PATIENTS: Three hundred ninety-seven men and 287 women with more than three months on MHD. PREDICTOR VARIABLE: Gender. OUTCOME MEASURES: The patient's self-reported nausea, vomiting, diarrhea, and reduced appetite. The malnutrition-inflammation score (MIS) was used to assess nutritional status. RESULTS: The prevalence of symptoms was 24.3% for reduced appetite, 19.7% for nausea, 12.3% for vomiting, and 3.5% for diarrhea. In a logistic regression model with adjustments for age, diabetes, congestive heart failure, hemoglobin, albumin, Kt/V, and years on dialysis, women were found to have significantly higher odds of reduced appetite (odds ratio [OR] = 1.97), nausea (OR = 1.90), and vomiting (OR = 2.21). MIS was 5.41 ± 3.18 for women and 4.66 ± 3.28 for men (P = .002) corresponding to a percentage difference of 13.86%. The female-male difference reduced by more than half after excluding the gastrointestinal symptoms component and by approximately 65% after excluding both the gastrointestinal symptoms and the dietary intake components from the MIS. CONCLUSIONS: The results suggest that the prevalences of nausea, vomiting, and reduced appetite are higher in women than in men on MHD. These gastrointestinal symptoms and perhaps their detrimental effects on dietary intake may partially explain a poorer nutritional status in MHD women.

Computed tomography-guided percutaneous biopsy of head and neck masses: techniques, outcomes, and complications.

OBJECTIVE: To assess the technique, efficacy, and safety of computed tomography (CT)-guided percutaneous biopsies of head and neck masses. MATERIALS AND METHODS: This was a retrospective, single-center study of CT-guided percutaneous core-needle biopsies of head and neck masses. For the analysis of diagnostic accuracy, biopsy results were compared with the final diagnosis, which was determined by histological examination and clinical follow-up. RESULTS: We evaluated 74 biopsies performed in 68 patients. The mean age of the patients was 55.6 years. Most of the lesions (79.7%) were located in the suprahyoid region, and the maximum diameter ranged from 11 mm to 128 mm. The most common approaches were paramaxillary (in 32.4%), retromandibular (in 21.6%), and periorbital (in 14.9%). Five patients (6.8%) developed minor complications. The presence of a complication did not show a statistically significant association with any clinical, radiological, or procedure-related factor. Sufficient material for histological analysis was obtained in all procedures. Thirty-eight biopsies (51.4%) yielded a histological diagnosis of malignancy. There was a false-negative result in three cases (8.3%), and there were no false-positive results. The procedure had a sensitivity of 92.7%, a specificity of 100%, and an accuracy of 96.0%. CONCLUSION: Our results demonstrate that CT-guided percutaneous core-needle biopsy of head and neck lesions is a safe, effective procedure for obtaining biological material for histological analysis.

OBJETIVO: Avaliar a técnica, eficácia e segurança das biópsias percutâneas guiadas por tomografia computadorizada (TC) de lesões de cabeça e pescoço. MATERIAIS E MÉTODOS: Este estudo retrospectivo e unicêntrico incluiu pacientes submetidos a biópsia percutânea guiada por TC de lesões de cabeça e pescoço. Para avaliação da acurácia diagnóstica, os resultados da biópsia foram comparados com o diagnóstico final determinado por avaliação histológica ou acompanhamento clínico. RESULTADOS: Foram avaliadas 74 biópsias realizadas em 68 pacientes. A média de idade dos pacientes foi de 55,6 anos. A maioria das lesões (79,7%) estava localizada na região supra-hioide e o maior diâmetro variou de 11 a 128 mm. Os acessos mais comuns utilizados foram paramaxilar (32,4%), retromandibular (21,6%) e periorbital (14,9%). Cinco pacientes (6,8%) desenvolveram complicações menores e não houve associação estatisticamente significante entre a presença de complicações e fatores clínicos, radiológicos ou relacionados ao procedimento. Foi obtido material suficiente para análise histológica em todos os casos. Trinta e oito biópsias (51,4%) tiveram diagnóstico histológico de malignidade. Houve três (8,3%) resultados falso-negativos e nenhum falso-positivo, demonstrando sensibilidade de 92,7%, especificidade de 100% e acurácia de 96,0%. CONCLUSÃO: Nossos resultados demonstram que a biópsia percutânea guiada por TC de lesões de cabeça e pescoço é um procedimento seguro e efetivo para obter material para análise histológica.

[Prescription of phosphorus binders and calcitriol for chronic hemodialysis patients]. / Prescrição de quelantes de fósforo e calcitriol para pacientes em hemodiálise crônica.

OBJECTIVE: To describe the frequency of prescription of phosphate binders (PB) and calcitriol for patients on chronic hemodialysis in Salvador, Brazil, and to assess whether treatment is in agreement with recommendations of the Kidney Disease Outcomes Quality Initiative (K/DOQI). METHODS: Cross section of baseline data of the PROHEMO study. The frequency of prescription of PB and calcitriol according to laboratory indicators of mineral metabolism was compared with K/DOQI recommendations. RESULTS: Sevelamer alone (i.e., not combined with other PB) was prescribed for 45.4% of patients, calcium carbonate (CaCO3) alone for 26.5%, sevelamer combined with CaCO3 for 2.1% and calcium acetate for 5.2%. Prescription of PB was noted in 53% of the patients with phosphorus <3.5 mg/dL and 40% with phosphorus <3.0 mg/dL. In disagreement with K/DOQI, prescription of calcitriol was found in 19% of patients with PTH<150 pg/mL and prescription was absent for approximately 35.4% with PTH>300 pg/dL combined with phosphorus equal or less than 5.5 mg/dL, calcium equal or less than 9.5 mg/dL and calcium x phosphorus product (CaxP)<55 mg2/dL2. For this latter group 38% had a prescription of sevelamer without other phosphate binders. CONCLUSION: Results show a large percentage of prescriptions of sevelamer among patients on maintenance hemodialysis in a Brazilian city, despite the high cost of the medication and absence of contraindications for PB with calcium salts. Results in patients with PTH<150 pg/mL and with PTH>300 pg/mL combined with certain concentrations of calcium, phosphate and CaxP also indicate the need to evaluate practices for use of phosphate binders and calcitriol.

Brazilian Consensus on the Application of Thermal Ablation for Treatment of Thyroid Nodules: A Task Force Statement by the Brazilian Society of Interventional Radiology and Endovascular Surgery (SOBRICE), Brazilian Society of Head and Neck Surgery (SBCCP), and Brazilian Society of Endocrinology and Metabolism (SBEM)

ABSTRACT There is increasing interest in ultrasound-guided ablation treatments for thyroid diseases, including benign and malignant ones. Surgeons, radiologists, and endocrinologists carry out these treatments, and various organizations within these specialties have recently released multiple international consensus statements and clinical practice standards. The aim of the present consensus statement is to provide guidance, cohesion, and standardization of best practices for thermal ablation procedures of thyroid nodules. The statement includes the indications for these procedures, preprocedural evaluations, technical aspects of the procedures, posttreatment care, follow-up, complications, and training recommendations. This document was written by a panel of specialists from the Brazilian Society of Interventional Radiology and Endovascular Surgery (SOBRICE), the Brazilian Society of Head and Neck Surgery (SBCCP), and the Brazilian Society of Endocrinology and Metabolism (SBEM). The statement does not aim to provide criteria for assessing the capability of specialists to perform the procedure. Instead, it aims to promote the standardization of best practices to reduce potential adverse outcomes. Additionally, it strives to enhance the delivery of high-quality care and the widespread adoption of these technologies on a national level. The recommendations collectively serve as a guidebook for applying best practices in thyroid ablation.

Computed tomography-guided preoperative localization of musculoskeletal lesions using the ROLL technique.

OBJECTIVE: To describe the preoperative localization of musculoskeletal lesions with the radioguided occult lesion localization (ROLL) technique. MATERIALS AND METHODS: In all cases, computed tomography-guided injection of technetium-99m sulfur colloid was performed, directly into or near the suspicious lesion, up to 36 hours before the surgical procedure. Lesions were detected intraoperatively with a gamma probe. RESULTS: We report the cases of six patients submitted to radioguided surgery, including three patients with bone lesions suspicious for metastasis, two patients suspected of recurrent sarcoma, and one patient with no previous diagnosis who had a nodular lesion on the left leg. Patients tolerated the procedure well, and no complications were associated with the puncture. All marked lesions were easily identified intraoperatively and were excised with clear margins. CONCLUSION: The ROLL technique was effective in the intraoperative localization of occult musculoskeletal lesions, demonstrating that it is a feasible and promising technique for the surgical exploration of selected cases.

Percutaneous stent placement for the treatment of malignant biliary obstruction: nitinol versus elgiloy stents.

OBJECTIVE: This study aimed to compare two self-expanding stents, a nitinol stent and an elgiloy stent, both placed percutaneously, in terms of their efficacy in palliating inoperable malignant biliary obstruction. MATERIALS AND METHODS: We retrospectively investigated 99 patients with unresectable malignant biliary obstruction treated with percutaneous placement of a self-expanding metallic stent at our institution between May 2007 and January 2010. Serum bilirubin and liver enzyme levels were measured before and 30 days after stenting. For all procedures using elgiloy or nitinol stents, stent occlusion and patient survival rates were calculated using Kaplan-Meyer analysis. RESULTS: All of the patients showed clinical improvement after stent placement, with no difference between the two groups. In both groups, the occlusion-free survival rate was 67% at 30 days, 37% at 90 days, 25% at 180 days, and 10% at 360 days, with no significant difference in relation to the type of stent. CONCLUSION: The two stents evaluated showed comparable efficacy for the percutaneous treatment of unresectable biliary malignancy, with good clinical results.

OBJETIVO: Este estudo procurou comparar a eficácia do implante percutâneo do stent autoexpansível de nitinol versus o stent de elgiloy para paliação da obstrução biliar maligna irressecável. MATERIAIS E MÉTODOS: Nós investigamos, retrospectivamente, 99 pacientes com obstrução maligna irressecável tratada com implante percutâneo de stent metálico autoexpansível em nossa instituição, de março de 2007 até janeiro de 2010. Os níveis séricos de bilirrubina e enzimas hepáticas foram medidos antes e 30 dias após o implante do stent. Para os procedimentos em que foi utilizado o stent de elgiloy ou o stent de nitinol, as taxas de oclusão dos stents e as taxas de sobrevida dos pacientes foram calculadas pela análise de Kaplan-Meyer. RESULTADOS: Os pacientes mostraram melhora clínica após o implante dos stents, sem diferença entre os dois grupos. As taxas de sobrevida livre de oclusão foram 67% aos 30 dias, 37% aos 90 dias, 25% aos 180 dias e 10% aos 360 dias para ambos os grupos, sem diferença significativa em relação ao tipo de stent. CONCLUSÃO: Os dois stents mostraram eficácias comparáveis no tratamento da doença biliar maligna irressecável, com bons resultados clínicos.

Computed tomography-guided percutaneous biopsy of head and neck masses: techniques, outcomes, and complications / Biópsia percutânea guiada por tomografia computadorizada de lesões de cabeça e pescoço: técnicas, resultados e complicações

Abstract Objective: To assess the technique, efficacy, and safety of computed tomography (CT)-guided percutaneous biopsies of head and neck masses. Materials and Methods: This was a retrospective, single-center study of CT-guided percutaneous core-needle biopsies of head and neck masses. For the analysis of diagnostic accuracy, biopsy results were compared with the final diagnosis, which was determined by histological examination and clinical follow-up. Results: We evaluated 74 biopsies performed in 68 patients. The mean age of the patients was 55.6 years. Most of the lesions (79.7%) were located in the suprahyoid region, and the maximum diameter ranged from 11 mm to 128 mm. The most common approaches were paramaxillary (in 32.4%), retromandibular (in 21.6%), and periorbital (in 14.9%). Five patients (6.8%) developed minor complications. The presence of a complication did not show a statistically significant association with any clinical, radiological, or procedure-related factor. Sufficient material for histological analysis was obtained in all procedures. Thirty-eight biopsies (51.4%) yielded a histological diagnosis of malignancy. There was a false-negative result in three cases (8.3%), and there were no false-positive results. The procedure had a sensitivity of 92.7%, a specificity of 100%, and an accuracy of 96.0%. Conclusion: Our results demonstrate that CT-guided percutaneous core-needle biopsy of head and neck lesions is a safe, effective procedure for obtaining biological material for histological analysis.

Resumo Objetivo: Avaliar a técnica, eficácia e segurança das biópsias percutâneas guiadas por tomografia computadorizada (TC) de lesões de cabeça e pescoço. Materiais e Métodos: Este estudo retrospectivo e unicêntrico incluiu pacientes submetidos a biópsia percutânea guiada por TC de lesões de cabeça e pescoço. Para avaliação da acurácia diagnóstica, os resultados da biópsia foram comparados com o diagnóstico final determinado por avaliação histológica ou acompanhamento clínico. Resultados: Foram avaliadas 74 biópsias realizadas em 68 pacientes. A média de idade dos pacientes foi de 55,6 anos. A maioria das lesões (79,7%) estava localizada na região supra-hioide e o maior diâmetro variou de 11 a 128 mm. Os acessos mais comuns utilizados foram paramaxilar (32,4%), retromandibular (21,6%) e periorbital (14,9%). Cinco pacientes (6,8%) desenvolveram complicações menores e não houve associação estatisticamente significante entre a presença de complicações e fatores clínicos, radiológicos ou relacionados ao procedimento. Foi obtido material suficiente para análise histológica em todos os casos. Trinta e oito biópsias (51,4%) tiveram diagnóstico histológico de malignidade. Houve três (8,3%) resultados falso-negativos e nenhum falso-positivo, demonstrando sensibilidade de 92,7%, especificidade de 100% e acurácia de 96,0%. Conclusão: Nossos resultados demonstram que a biópsia percutânea guiada por TC de lesões de cabeça e pescoço é um procedimento seguro e efetivo para obter material para análise histológica.

Uncommon primary tumors of the orbit diagnosed by computed tomography-guided core needle biopsy: report of two cases.

Computed tomography-guided percutaneous biopsy is a safe and effective alternative method for evaluating selected intra-orbital lesions where the preoperative diagnosis is important for the therapeutic planning. The authors describe two cases of patients with uncommon primary orbital tumors whose diagnosis was obtained by means of computed tomography-guided core needle biopsy, with emphasis on the technical aspects of the procedure.

Biópsia percutânea guiada por tomografia computadorizada é uma alternativa segura e eficaz para avaliação de lesões intraorbitárias selecionadas, em que o diagnóstico pré-operatório é importante para o planejamento terapêutico. Descrevemos dois casos de pacientes com tumores orbitários incomuns em que o diagnóstico foi obtido por biópsia com agulha grossa guiada por tomografia computadorizada, dando ênfase para os aspectos técnicos do procedimento.

Computed tomography-guided preoperative localization of musculoskeletal lesions using the ROLL technique / Localização pré-operatória guiada por tomografia computadorizada de lesões musculoesqueléticas utilizando a técnica ROLL

Abstract Objective: To describe the preoperative localization of musculoskeletal lesions with the radioguided occult lesion localization (ROLL) technique. Materials and Methods: In all cases, computed tomography-guided injection of technetium-99m sulfur colloid was performed, directly into or near the suspicious lesion, up to 36 hours before the surgical procedure. Lesions were detected intraoperatively with a gamma probe. Results: We report the cases of six patients submitted to radioguided surgery, including three patients with bone lesions suspicious for metastasis, two patients suspected of recurrent sarcoma, and one patient with no previous diagnosis who had a nodular lesion on the left leg. Patients tolerated the procedure well, and no complications were associated with the puncture. All marked lesions were easily identified intraoperatively and were excised with clear margins. Conclusion: The ROLL technique was effective in the intraoperative localization of occult musculoskeletal lesions, demonstrating that it is a feasible and promising technique for the surgical exploration of selected cases.

Resumo Objetivo: Descrever a localização pré-operatória de lesões musculoesqueléticas utilizando a técnica radioguided occult lesion localization (ROLL). Materiais e Métodos: Em todos os casos foi realizada administração guiada por tomografia computadorizada de enxofre coloidal marcado com tecnécio-99m, diretamente no interior ou adjacente à lesão suspeita, até 36 horas antes do procedimento cirúrgico. As lesões foram localizadas no intraoperatório utilizando um gama-probe. Resultados: São descritos seis casos de pacientes submetidos a cirurgia radioguiada, sendo três pacientes com lesões ósseas suspeitas para metástase, dois pacientes com sarcoma recidivado e um paciente com lesão nodular na perna esquerda sem diagnóstico prévio. Os pacientes toleraram bem o procedimento e não ocorreram complicações. Todas as lesões foram identificadas adequadamente no intraoperatório e ressecadas com margens livres. Conclusão: A técnica ROLL foi efetiva na localização intraoperatória de lesões musculoesqueléticas ocultas, demonstrando que este procedimento é factível e promissor para facilitar a exploração cirúrgica em casos selecionados.

Percutaneous stent placement for the treatment of malignant biliary obstruction: nitinol versus elgiloy stents / Tratamento percutâneo de obstrução biliar maligna: comparação entre os stents nitinol e elgiloy

Abstract Objective: This study aimed to compare two self-expanding stents, a nitinol stent and an elgiloy stent, both placed percutaneously, in terms of their efficacy in palliating inoperable malignant biliary obstruction. Materials and Methods: We retrospectively investigated 99 patients with unresectable malignant biliary obstruction treated with percutaneous placement of a self-expanding metallic stent at our institution between May 2007 and January 2010. Serum bilirubin and liver enzyme levels were measured before and 30 days after stenting. For all procedures using elgiloy or nitinol stents, stent occlusion and patient survival rates were calculated using Kaplan-Meyer analysis. Results: All of the patients showed clinical improvement after stent placement, with no difference between the two groups. In both groups, the occlusion-free survival rate was 67% at 30 days, 37% at 90 days, 25% at 180 days, and 10% at 360 days, with no significant difference in relation to the type of stent. Conclusion: The two stents evaluated showed comparable efficacy for the percutaneous treatment of unresectable biliary malignancy, with good clinical results.

Resumo Objetivo: Este estudo procurou comparar a eficácia do implante percutâneo do stent autoexpansível de nitinol versus o stent de elgiloy para paliação da obstrução biliar maligna irressecável. Materiais e Métodos: Nós investigamos, retrospectivamente, 99 pacientes com obstrução maligna irressecável tratada com implante percutâneo de stent metálico autoexpansível em nossa instituição, de março de 2007 até janeiro de 2010. Os níveis séricos de bilirrubina e enzimas hepáticas foram medidos antes e 30 dias após o implante do stent. Para os procedimentos em que foi utilizado o stent de elgiloy ou o stent de nitinol, as taxas de oclusão dos stents e as taxas de sobrevida dos pacientes foram calculadas pela análise de Kaplan-Meyer. Resultados: Os pacientes mostraram melhora clínica após o implante dos stents, sem diferença entre os dois grupos. As taxas de sobrevida livre de oclusão foram 67% aos 30 dias, 37% aos 90 dias, 25% aos 180 dias e 10% aos 360 dias para ambos os grupos, sem diferença significativa em relação ao tipo de stent. Conclusão: Os dois stents mostraram eficácias comparáveis no tratamento da doença biliar maligna irressecável, com bons resultados clínicos.

Tumores primários da órbita incomuns diagnosticados por biópsia com agulha grossa guiada por tomografia computadorizada: relato de dois casos / Uncommon primary tumors of the orbit diagnosed by computed tomography-guided core needle biopsy: report of two cases

Biópsia percutânea guiada por tomografia computadorizada é uma alternativa segura e eficaz para avaliação de lesões intraorbitárias selecionadas, em que o diagnóstico pré-operatório é importante para o planejamento terapêutico. Descrevemos dois casos de pacientes com tumores orbitários incomuns em que o diagnóstico foi obtido por biópsia com agulha grossa guiada por tomografia computadorizada, dando ênfase para os aspectos técnicos do procedimento.

Computed tomography-guided percutaneous biopsy is a safe and effective alternative method for evaluating selected intra-orbital lesions where the preoperative diagnosis is important for the therapeutic planning. The authors describe two cases of patients with uncommon primary orbital tumors whose diagnosis was obtained by means of computed tomography-guided core needle biopsy, with emphasis on the technical aspects of the procedure.

Pulmonary interstitial emphysema: a case report and review of the literature / Enfisema intersticial pulmonar: relato de caso e revisão da literatura

Pulmonary interstitial emphysema is a rare condition that generally affects low-weight preterm infants submitted to mechanical ventilation. The prognosis is variable, depending on early diagnosis and treatment. The radiologist plays a key role in this scenario. The authors report a case of persistent pulmonary interstitial emphysema, describing the main characteristics of such entity.

O enfisema intersticial pulmonar é uma condição rara que acomete, em geral, recém-nascidos pré-termos de baixo peso submetidos a ventilação mecânica. O prognóstico é variável e dependente do diagnóstico e tratamento precoces, ressaltando-se a importância do radiologista neste cenário. Os autores relatam um caso de enfisema intersticial pulmonar persistente, abordando as principais características desta entidade.

Prescrição de quelantes de fósforo e calcitriol para pacientes em hemodiálise crônica / Prescription of phosphorus binders and calcitriol for chronic hemodialysis patients

OBJETIVO: Descrever a frequência de prescrição de quelantes de fósforo (QF) e calcitriol em pacientes sob hemodiálise (HD) crônica em Salvador, Brasil, e avaliar se o tratamento está de acordo com recomendações do Kidney Disease Outcomes Quality Initiative (K/DOQI). MÉTODOS: Corte transversal de dados da linha de base do Estudo Prospectivo do Prognóstico de Pacientes Tratados Cronicamente por Hemodiálise (PROHEMO). Foi realizada descrição da frequência de prescrição de QF e calcitriol conforme as concentrações de indicadores laboratoriais do metabolismo mineral, comparando com recomendações do K/DOQI. RESULTADOS: Sevelamer isoladamente (i.e., não combinado com outro QF) foi prescrito para 45,4 por cento dos pacientes, carbonato de cálcio (CaCO3) isoladamente para 26,5 por cento, sevelamer combinado com CaCO3 para 2,1 por cento e acetato de cálcio para 5,2 por cento. Prescrição de QF foi observada para 53 por cento dos pacientes com fósforo <3,5 mg/dL e 40 por cento com fósforo <3,0 mg/dL. Em desacordo com K/DOQI, prescrição de calcitriol foi detectada para 19 por cento dos pacientes com PTH<150 pg/mL e ausência da prescrição para aproximadamente 35,4 por cento com PTH>300 pg/dL combinado com fósforo menor ou igual a 5,5 mg/dL, cálcio menor ou igual a 9,5 mg/dL e produto cálcio e fósforo (CaxP)<55 mg2/dL2. Neste último grupo, 38 por cento tiveram prescrição de sevelamer sem outro QF. CONCLUSÃO: Os resultados mostram um elevado percentual de prescrição de sevelamer em pacientes em HD de manutenção em uma cidade brasileira, apesar do alto custo deste medicamento e ausência de contraindicação para QF à base de cálcio. Os resultados em pacientes com PTH<150 pg/mL e com PTH>300 pg/mL combinado com determinadas concentrações de cálcio, fósforo e CaxP indicam também a necessidade de avaliar as práticas de uso de QF e calcitriol.

OBJECTIVE: To describe the frequency of prescription of phosphate binders (PB) and calcitriol for patients on chronic hemodialysis in Salvador, Brazil, and to assess whether treatment is in agreement with recommendations of the Kidney Disease Outcomes Quality Initiative (K/DOQI). METHODS: Cross section of baseline data of the PROHEMO study. The frequency of prescription of PB and calcitriol according to laboratory indicators of mineral metabolism was compared with K/DOQI recommendations. RESULTS: Sevelamer alone (i.e., not combined with other PB) was prescribed for 45.4 percent of patients, calcium carbonate (CaCO3) alone for 26.5 percent, sevelamer combined with CaCO3 for 2.1 percent and calcium acetate for 5.2 percent. Prescription of PB was noted in 53 percent of the patients with phosphorus <3.5 mg/dL and 40 percent with phosphorus <3.0 mg/dL. In disagreement with K/DOQI, prescription of calcitriol was found in 19 percent of patients with PTH<150 pg/mL and prescription was absent for approximately 35.4 percent with PTH>300 pg/dL combined with phosphorus equal or less than 5.5 mg/dL, calcium equal or less than 9.5 mg/dL and calcium x phosphorus product (CaxP)<55 mg2/dL2. For this latter group 38 percent had a prescription of sevelamer without other phosphate binders. CONCLUSION: Results show a large percentage of prescriptions of sevelamer among patients on maintenance hemodialysis in a Brazilian city, despite the high cost of the medication and absence of contraindications for PB with calcium salts. Results in patients with PTH<150 pg/mL and with PTH>300 pg/mL combined with certain concentrations of calcium, phosphate and CaxP also indicate the need to evaluate practices for use of phosphate binders and calcitriol.