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Soares LBM, Soares AB, Ferreira JBB. Overview of global healthcare policies for patients with chronic kidney disease: an integrative literature review. EINSTEIN-SAO PAULO 2024; 22:eRW0519. [PMID: 39046071 PMCID: PMC11221832 DOI: 10.31744/einstein_journal/2024rw0519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/07/2023] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Chronic kidney disease is a progressive and irreversible loss of kidney function and considerably affects the lives of patients and their families. Its high incidence necessitates efficient public policies for prevention and treatment. However, policies for chronic kidney disease education and awareness are scarce. OBJECTIVE To evaluate global public policies for the prevention and treatment of chronic kidney disease adopted in various regions, aiming to comprehend the differences between various models. METHODS This integrative review followed PRISMA recommendations and included papers published between 2016 and 2021 across several databases. RESULTS The 44 selected articles were categorized into three themes: structural and financial aspects of the organization of renal healthcare, access to renal healthcare or management of chronic kidney disease, and coping strategies for chronic kidney disease or kidney health. Critical analysis of the papers revealed global neglect of kidney disease in political agendas. Considerable policy variations exist between different countries and regions of the same country. Our research highlighted that free and universal health coverage, especially for the most vulnerable patients, is crucial for accessing treatment owing to the prohibitively high treatment costs. CONCLUSION Social, economic, and ethnic inequalities strongly correlate with disease occurrence, primarily affecting minority groups who lack health support, especially for the prevention and treatment of chronic kidney disease.
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Affiliation(s)
- Letícia Borges Mendonça Soares
- Postgraduate Program in Public HealthFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Postgraduate Program in Public Health, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo,Ribeirão Preto, SP, Brazil.
| | - Alcimar Barbosa Soares
- Program in Biomedic Postgraduate al EngineeringFaculdade de Engenharia ElétricaUniversidade Federal de UberlândiaUberlândiaMGBrazil Program in Biomedic Postgraduate al Engineering, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
| | - Janise Braga Barros Ferreira
- Postgraduate Program in Public HealthFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Postgraduate Program in Public Health, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo,Ribeirão Preto, SP, Brazil.
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Hauwanga WN, Alphonse B, Akram I, Djeagou A, Lima Pessôa B, McBenedict B. Decadal Analysis of Age-Adjusted Mortality Rates for Acute and Chronic Kidney Disease in Brazil, 2000-2021. Cureus 2024; 16:e61657. [PMID: 38966439 PMCID: PMC11223587 DOI: 10.7759/cureus.61657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/04/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction Renal failure, comprising acute kidney injury (AKI) and chronic kidney disease (CKD), involves a decline or loss of kidney function. AKI is sudden and reversible, with a rapid decline in function over hours to days, while CKD involves persistent abnormalities lasting at least three months. Developing countries are seeing a rise in AKI cases, especially in critically ill patients. Globally, there's a growing occurrence and mortality rate linked to CKD. Methods The study used a retrospective cross-sectional design to analyze AKI and CKD mortality rates in Brazil from 2019 to 2022. Data on population and demographics, including sex and age, were obtained from the Brazilian Institute of Geography and Statistics. Mortality data for kidney diseases were sourced from the Brazilian Hospital Information System. The analysis utilized the Joinpoint Regression Program to calculate average annual percentage changes (AAPCs) and their respective 95% confidence intervals. Weighted Bayesian information criterion was used to determine the significance levels and identify the best-fitting combination of line segments and joinpoints. Results The study findings revealed a significant rise in AKI mortality rates for both males and females, from 2008 to 2021 (APC = 3.16; CI: 2.29 to 5.93), with higher mortality rates recorded among males compared to women over the entire study period. Analyses according to age groups showed that males between the ages 40 to 49 experienced the most rapid increase in mortality during the 2019 - 2021 period (APC = 35.41; CI: 16.72 to 46.57); meanwhile, the most rapid increase in mortality for females was observed from 2019 to 2021, and this was among those aged 30 to 39 (APC = 40.33; CI = 6.48 to 59.78). Furthermore, there was an observable upward trend in mortality related to CKD (APC = 0.70; CI: 0.41 to 1.01), with males consistently having higher mortality rates throughout the entire study period. The elderly population, both males and females, experienced the most rapid increase in CKD-related mortality, with AAPC values of 2.32 (CI: 1.82 to 2.89) for males and 1.62 (CI: 1.08 to 2.10) for females. Conclusion We observed a consistent increase in mortality rates from acute kidney diseases for both males and females since 2008, with males experiencing higher mortality rates overall. The study highlighted the need for further research to understand the underlying factors contributing to these trends. Additionally, interventions targeting modifiable risk factors and improving access to healthcare could help reduce mortality related to renal failure.
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Affiliation(s)
- Wilhelmina N Hauwanga
- Family Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, BRA
| | | | - Ifrah Akram
- Neurosurgery, Fluminense Federal University, Niterói, BRA
| | - Albine Djeagou
- Neurosurgery, Fluminense Federal University, Niterói, BRA
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do Nascimento Lima H, Monárrez-Espino J, Nerbass FB, Moura-Neto JA, Sesso R, Lugon JR. Comparison of 1-year survival between patients initiating chronic hemodialysis under public and private health insurance: register-based data analysis from Brazil. Int Urol Nephrol 2024:10.1007/s11255-024-04018-4. [PMID: 38578392 DOI: 10.1007/s11255-024-04018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
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.
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Affiliation(s)
- Helbert do Nascimento Lima
- Medicine Department, University of the Region of Joinville (Univille), Rua Rio do Sul 270, Joinville, Santa Catarina, 89202-201, Brazil.
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
- Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil.
| | - Joel Monárrez-Espino
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - José A Moura-Neto
- Internal Medicine Division, Bahiana School of Medicine and Public Health, Salvador, Brazil
- Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil
| | - Ricardo Sesso
- Nephrology Division, Federal University of São Paulo, Sao Paulo, Brazil
- Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil
| | - Jocemir Ronaldo Lugon
- Nephrology Division, Universidade Federal Fluminense (UFF), Niterói, Brazil
- Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil
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Tompson MEC, Pimentel JAVDO, Silva MDA, Santos-Veloso MAO, Lordsleem ABDMDS, de Lima SG. Progression of valve heart disease in a cohort of patients undergoing renal replacement therapy. J Bras Nefrol 2024; 46:e20230036. [PMID: 37955523 PMCID: PMC11210540 DOI: 10.1590/2175-8239-jbn-2023-0036en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/27/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION Cardiovascular disease is an important cause of death among patients with chronic kidney disease (CKD). Valve calcification is a predictor of cardiovascular mortality and coronary artery disease. OBJECTIVE To assess heart valve disease frequency, associated factors, and progression in CKD patients. METHODS We conducted a retrospective study on 291 CKD patients at Hospital das Clínicas de Pernambuco. Inclusion criteria were age ≥ 18 with CKD and valve disease, while those on conservative management or with missing data were excluded. Clinical and laboratory variables were compared, and patients were categorized by dialysis duration (<5 years; 5-10 years; >10 years). Statistical tests, including chi-square, Fisher's exact, ANOVA, and Kruskal-Wallis, were employed as needed. Simple and multivariate binary regression models were used to analyze valve disease associations with dialysis duration. Significance was defined as p < 0.05. RESULTS Mitral valve disease was present in 82.5% (240) of patients, followed by aortic valve disease (65.6%; 86). Over time, 106 (36.4%) patients developed valve disease. No significant association was found between aortic, pulmonary, mitral, or tricuspid valve disease and dialysis duration. Secondary hyperparathyroidism was the sole statistically significant factor for mitral valve disease in the regression model (OR 2.59 [95% CI: 1.09-6.18]; p = 0.031). CONCLUSION CKD patients on renal replacement therapy exhibit a high frequency of valve disease, particularly mitral and aortic valve disease. However, no link was established between dialysis duration and valve disease occurrence or progression.
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Affiliation(s)
| | | | | | - Marcelo Antônio Oliveira Santos-Veloso
- Hospital Alfa, Serviço de Clínica Médica, Recife, PE, Brasil
- Universidade Federal de Pernambuco, Centro de Biociências, Recife, PE, Brazil
- Centro Universitário Maurício de Nassau, Faculdade de Medicina, Recife, PE, Brazil
| | - Andrea Bezerra de Melo da Silveira Lordsleem
- Centro Universitário Maurício de Nassau, Faculdade de Medicina, Recife, PE, Brazil
- Universidade Federal de Pernambuco, Hospital das Clínicas, Serviço de Cardiologia, Recife, PE, Brazil
| | - Sandro Gonçalves de Lima
- Centro Universitário Maurício de Nassau, Faculdade de Medicina, Recife, PE, Brazil
- Universidade Federal de Pernambuco, Hospital das Clínicas, Serviço de Cardiologia, Recife, PE, Brazil
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Amorim LC, Cherchiglia ML, Reis IA. [Beneficiaries of private health plans that used the public outpatient hemodialysis network in Brazil between 2012 and 2019]. CAD SAUDE PUBLICA 2023; 39:e00188422. [PMID: 37820235 PMCID: PMC10566561 DOI: 10.1590/0102-311xpt188422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 10/13/2023] Open
Abstract
Reimbursement to Brazilian Unified National Health System (SUS) is the most visible interface of the public-private relationship and its analysis can expand our understanding of the use of SUS by the supplementary sector. The study aims to characterize the beneficiaries of private health plans who underwent hemodialysis in the SUS, from 2012 to 2019, in relation to: gender, age group, region of residence, characteristics of the private health plans and the operators and of the care provided to them. The characteristics of the private health plans and the modality of the operators of the beneficiaries where then compared with data of the other beneficiaries in Brazil. An individual-centered database was constructed based on data from the Brazilian National Supplementary Health Agency (ANS); information on beneficiaries in Brazil was consulted in Brazilian Health Informatics Department (DATASUS). Frequency distributions were used to summarize the data, standardization by age and sex for characteristics of the private health plans and modality of the operators and ratio to compare frequencies. A total of 31,941 beneficiaries underwent hemodialysis in the SUS, 11,147 (34.9%) outside their municipality of residence, and 6,423 (20.11%) used the SUS for 25 months or more. When compared with other beneficiaries in Brazil, those who underwent hemodialysis in the SUS were more frequently linked to old private health plans (ratio, r = 2.41), collective by adherence (r = 1.76), individual/family (r = 1.36), outpatient (r = 4.66), municipal (r = 3.88), and/or philanthropic (r = 7.32). Private health plans with restrictive characteristics may have hindered the access of beneficiaries who performed hemodialysis in SUS to the networks of their operators and have represented one more among the factors that may have influenced the use of SUS by those beneficiaries, even with coverage provided for in their contracts.
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Affiliation(s)
| | | | - Ilka Afonso Reis
- Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Nerbass FB, Lima HDN, Lugon JR, Sesso R. Hemodialysis in Brazil: differences across geographic regions regarding demographics, laboratory parameters and drug prescription. J Bras Nefrol 2023; 45:410-416. [PMID: 37395543 PMCID: PMC10726669 DOI: 10.1590/2175-8239-jbn-2022-0169en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/10/2023] [Indexed: 07/04/2023] Open
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.
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Affiliation(s)
| | | | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Barreto J, Borges C, Rodrigues TB, Jesus DC, Campos-Staffico AM, Nadruz W, Luiz da Costa J, Bueno de Oliveira R, Sposito AC. Pharmacokinetic Properties of Dapagliflozin in Hemodialysis and Peritoneal Dialysis Patients. Clin J Am Soc Nephrol 2023; 18:1051-1058. [PMID: 37227937 PMCID: PMC10564347 DOI: 10.2215/cjn.0000000000000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors attenuate incident cardiovascular outcomes, irrespective of baseline GFR, in conservatively managed CKD. As this condition inexorably progresses to demanding KRT, drug withdrawal is supported by the current lack of evidence of safety of SGLT2 inhibitors in dialysis. METHODS This study was a prospective, single-center, open-label trial ( ClinicalTrials.gov identifier: NCT05343078 ) aimed at assessing the pharmacokinetic properties and safety of dapagliflozin in patients with kidney failure on regular dialysis regimens compared with those with type 2 diabetes and age- and sex-matched controls with normal kidney function. Peripheral blood samples were collected from both groups every 30 minutes for 4 hours and again after 48 hours after ingestion of dapagliflozin 10 mg, which occurred immediately before dialysis session initiation in the kidney failure group. This protocol occurred in drug-naïve patients and again after six daily doses of dapagliflozin to assess whether the drug had accumulated. The plasma and dialysate levels of dapagliflozin at each time point were determined by liquid chromatography and used to calculate pharmacokinetics parameters (peak concentration [C max ] and area under the plasma concentration-versus-time curve) for each participant. RESULTS Dapagliflozin C max was 117 and 97.6 ng/ml in the kidney failure and control groups, respectively, whereas the corresponding accumulation ratios were 26.7% and 9.5%. No serious adverse events were reported for either group. Dapagliflozin recovered from dialysate corresponded to 0.10% of the administered dose. CONCLUSIONS In patients with kidney failure on dialysis, dapagliflozin was well tolerated, was slightly dialyzable, and had nonaccumulating pharmacokinetic properties. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Pharmacokinetics and Dialyzability of Dapagliflozin in Dialysis Patients (DARE-ESKD 1), NCT05343078.
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Affiliation(s)
- Joaquim Barreto
- Laboratory of Atherosclerosis and Vascular Biology (Aterolab), Cardiology Division, University of Campinas (Unicamp), Campinas, Brazil
| | - Cynthia Borges
- Laboratory for Evaluation of Mineral and Bone Disorders in Nephrology (LEMON), Nephrology Division, University of Campinas (Unicamp), Campinas, Brazil
| | - Tais Betoni Rodrigues
- Campinas Poison Control Center (CIATOX), School of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
| | - Daniel C. Jesus
- Laboratory of Atherosclerosis and Vascular Biology (Aterolab), Cardiology Division, University of Campinas (Unicamp), Campinas, Brazil
| | | | - Wilson Nadruz
- Cardiology Division, Clinics Hospital, University of Campinas (Unicamp), Campinas, Brazil
| | - Jose Luiz da Costa
- Campinas Poison Control Center (CIATOX), School of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
- Faculty of Pharmaceutical Sciences, University of Campinas (Unicamp), Campinas, Brazil
| | - Rodrigo Bueno de Oliveira
- Laboratory for Evaluation of Mineral and Bone Disorders in Nephrology (LEMON), Nephrology Division, University of Campinas (Unicamp), Campinas, Brazil
| | - Andrei C. Sposito
- Laboratory of Atherosclerosis and Vascular Biology (Aterolab), Cardiology Division, University of Campinas (Unicamp), Campinas, Brazil
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Nerbass FB, Lima HDN, Vieira Neto OM, Sesso R, Lugon JR. Prevalence and Determinants of Predialysis Dietitian Follow-Up: Results From the Brazilian Dialysis Registry. J Ren Nutr 2023; 33:97-102. [PMID: 35597320 DOI: 10.1053/j.jrn.2022.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/11/2022] [Accepted: 04/24/2022] [Indexed: 01/25/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Huarez B, Hernández-Vásquez A, Azañedo D, Vargas-Fernández R, Comandé D, Agüero-Palacios Y. Prevalence of hepatitis C virus infection in patients with end-stage renal disease in Latin America and the Caribbean: a systematic review and meta-analysis. Arch Virol 2022; 167:2653-2664. [PMID: 36195804 DOI: 10.1007/s00705-022-05604-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/13/2022] [Indexed: 12/14/2022]
Abstract
AIM To estimate the prevalence of hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD) undergoing hemodialysis in Latin America and the Caribbean (LAC). MATERIALS AND METHODS Observational studies published in Spanish, Portuguese, and English language by November 25, 2021, in PubMed, Embase, Web of Science, Scopus, SciELO, and LILACS were selected by two reviewers according to predefined eligibility criteria. Study quality was assessed using the US National Heart, Lung and Blood Institute tool for observational cohort and cross-sectional studies. A meta-analysis of proportions was performed using a random-effects model based on the DerSimonian and Laird method, using R. PROSPERO N°: CRD42018107403. RESULTS A total of 20 studies were included in the narrative synthesis (15 from Brazil, two from Cuba, two from Argentina, and one from Peru). Only 17 studies were included in the meta-analysis (13 from Brazil, two from Argentina, one from Cuba, and one from Peru). The overall prevalence of HCV in ESRD patients undergoing hemodialysis in LAC was 11.3% (95% confidence interval [CI]: 8.9% - 13.9%; I2: 99 %). In Brazil and Argentina, the prevalence was 6% and 26.1%, respectively. Prevalence after excluding poor-quality studies was 10.7%. CONCLUSION The prevalence of HCV in ESRD patients undergoing hemodialysis in LAC was 11.3%. The implementation of infection control measures in hemodialysis centers in LAC is required. It is also necessary to increase the number of studies on the subject in the ESRD population in most LAC countries.
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Affiliation(s)
- Bertha Huarez
- Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.
| | | | | | - Daniel Comandé
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Lopes JA, Ferreira MC, Otoni A, Baldoni AO, Domingueti CP. Is screening for chronic kidney disease in patients with diabetes mellitus being properly conducted in primary care? J Bras Nefrol 2022; 44:498-504. [PMID: 35202454 PMCID: PMC9838665 DOI: 10.1590/2175-8239-jbn-2021-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/11/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Screening patients with diabetes mellitus (DM) for chronic kidney disease (CKD) enables early diagnosis and helps to establish adequate treatment and avoid possible damages to health associated with disease progression. This study aimed to verify whether screening for CKD has been properly conducted in populations with diabetes mellitus seen at primary care clinics. METHODS This descriptive study included 265 individuals with DM seen at Basic Healthcare Clinics in Divinópolis, MG, Brazil. Clinical and laboratory data were collected from the Integrated Health System. Frequency of testing and kidney function evaluations performed within the last 12 months were calculated along with the proportion of patients with increased urinary albumin excretion (UAE) and decreased glomerular filtration rate (GFR) to determine the proportion of patient with kidney involvement. RESULTS We found that 41.2% of the patients had kidney involvement and that 61.2% of the individuals with kidney involvement were on nephroprotective medication. Of the 21.9% tested for isolated albuminuria, 46.5% had increased UAE. The albumin-to-creatinine ratio (ACR) was measured in 12.1% of the patients, with 43.8% having an increased ACR. We found that 89.0% of the patients had their serum creatinine levels measured, and that 33.1% had a decreased GFR. CONCLUSION CKD screening was more frequently performed via the GFR than UAE, a parameter analyzed only in a small proportion of patients. Therefore, CKD screening for patients with diabetes is not being performed properly in primary care.
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Affiliation(s)
| | | | - Alba Otoni
- Universidade Federal de São João del-Rei, Campus Centro-Oeste Dona Lindu, Divinópolis, MG, Brasil
| | - André Oliveira Baldoni
- Universidade Federal de São João del-Rei, Campus Centro-Oeste Dona Lindu, Divinópolis, MG, Brasil
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Rodrigues AS, de Abreu LC, Morais MJDD, Leitao FNC, do Amaral GLG, de Sousa Santos EF, do Souto RP. Temporal trend of mortality and hospitalization for chronic kidney disease in adults from Northern Brazil. Medicine (Baltimore) 2022; 101:e29702. [PMID: 35777060 PMCID: PMC9239633 DOI: 10.1097/md.0000000000029702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/22/2022] [Indexed: 01/05/2023] Open
Abstract
We aimed to evaluate mortality and hospital admissions for chronic kidney disease in young adults according to sex and state in the northern region of Brazil, between 1996 and 2017. A population-based time series study using official data on mortality and hospital admissions due to chronic kidney disease in individuals aged 20 to 49 years old, residents of the northern region of Brazil, in the periods 1996-2017 and to 2008-2017, respectively. Chronic kidney disease was defined according to the International Classification of Diseases, 10th revision (N18). The evolution of mortality from chronic kidney disease decreased by 0.881% per year over the period (1996-2017). In the states of Acre and Amapá, there was a reduction of 5.85% and -5.68% per year, respectively, and in Tocantins, an increase of 4.16% per year. The incidence of hospitalization did not vary between 2008 and 2017. However, 2 states showed an increase in hospitalization rates: Acre (6.08% per year) and Pará (2.83% per year), and 2 states showed a reduction: Amazonas (5.09% per year) and Tocantins (6.23% per year). In general, there was decrease in mortality rate overtime. However, rate of mortality due to chronic kidney disease increased in the state of Tocantins. The evolution of hospitalization due to chronic kidney disease in a population of young adults remained stationary.
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Affiliation(s)
- Alliny Sales Rodrigues
- Centro Universitário FMABC, Santo André, Sao Paulo, Brazil
- Acre State Health Secretariat (SESACRE), Rio Branco, Acre, Brazil
- Multidisciplinary Laboratory for Studies and Scientific Writing in Health Sciences (LaMEECCS), Federal University of Acre (UFAC), Rio Branco, Acre, Brazil
- Laboratory of Study Design and Scientific Writing (LaDEEC/FMABC), Santo Andre, Sao Paulo, Brazil
| | - Luiz Carlos de Abreu
- Centro Universitário FMABC, Santo André, Sao Paulo, Brazil
- Laboratory of Study Design and Scientific Writing (LaDEEC/FMABC), Santo Andre, Sao Paulo, Brazil
| | - Mauro Jose de Deus Morais
- Multidisciplinary Laboratory for Studies and Scientific Writing in Health Sciences (LaMEECCS), Federal University of Acre (UFAC), Rio Branco, Acre, Brazil
- Laboratory of Study Design and Scientific Writing (LaDEEC/FMABC), Santo Andre, Sao Paulo, Brazil
- Federal University of Acre (UFAC), Cruzeiro do Sul, Acre, Brazil
| | - Francisco Naildo Cardoso Leitao
- Centro Universitário FMABC, Santo André, Sao Paulo, Brazil
- Multidisciplinary Laboratory for Studies and Scientific Writing in Health Sciences (LaMEECCS), Federal University of Acre (UFAC), Rio Branco, Acre, Brazil
- Laboratory of Study Design and Scientific Writing (LaDEEC/FMABC), Santo Andre, Sao Paulo, Brazil
| | | | - Edige Felipe de Sousa Santos
- Centro Universitário FMABC, Santo André, Sao Paulo, Brazil
- Laboratory of Study Design and Scientific Writing (LaDEEC/FMABC), Santo Andre, Sao Paulo, Brazil
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Nerbass FB, Lima HDN, Thomé FS, Vieira Neto OM, Lugon JR, Sesso R. Brazilian Dialysis Survey 2020. J Bras Nefrol 2022; 44:349-357. [PMID: 35212702 PMCID: PMC9518621 DOI: 10.1590/2175-8239-jbn-2021-0198] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/02/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: National data on chronic dialysis treatment are essential to support the development of health policies aimed at improving the treatment for thousands of people. Objective: To report epidemiological data from the 2020 Brazilian Dialysis Survey, sponsored by the Brazilian Society of Nephrology. Methods: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire for the year, covering clinical and epidemiological aspects of patients in a chronic dialysis program, data on dialysis therapy, characteristics of dialysis units and the impact of the COVID-19 pandemic. Results: 235 (28%) of the centers responded to the questionnaire. In July 2020, the estimated total number of patients on dialysis was 144,779. The estimated prevalence and incidence rates of patients per million population (pmp) were 684 and 209, respectively. Of the prevalent patients, 92.6% were on hemodialysis (HD) and 7.4% were on peritoneal dialysis (PD); 23% were on the transplant waiting list. A central venous catheter was used by a quarter of patients on HD. The incidence rate of confirmed COVID-19 between February and July 2020 was 684/10,000 dialysis patients, and the lethality rate was 25.7%. The estimated overall mortality and COVID-19 crude annual mortality rates were 24.5 and 4.2%, respectively. Conclusion: The absolute number of patients on chronic dialysis and prevalence rate continued to increase. The low use of PD as dialysis therapy was maintained and the use of long-term catheters for HD increased. The COVID-19 pandemic contributed to the increase in the overall mortality rate.
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Affiliation(s)
| | | | | | | | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Lugon JR, Neves PDMDM, Pio-Abreu A, do Nascimento MM, Sesso R. Evaluation of central venous catheter and other risk factors for mortality in chronic hemodialysis patients with COVID-19 in Brazil. Int Urol Nephrol 2022; 54:193-199. [PMID: 34132971 PMCID: PMC8207494 DOI: 10.1007/s11255-021-02920-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Hemodialysis patients with COVID-19 are at increased risk of death. We aimed to describe the characteristics of a cohort of Brazilian hemodialysis patients with COVID-19 and assess their mortality rate and risk factors for death. METHODS Retrospective cohort study of 741 Brazilian hemodialysis patients with confirmed COVID-19 from Feb-Dec/2020, of 52 dialysis centers of the country. We analyzed comorbid conditions, sociodemographic factors, and dialysis-related parameters. To detect risk factors for mortality in hemodialysis patients, we performed multivariable Cox proportional hazard regression analysis. Survival was analyzed by Kaplan-Meier. RESULTS From 9877 hemodialysis patients, 741 were diagnosed with COVID-19. Mean age was 57 ± 16 years, 61% were male, and 51% white. The most frequent symptoms were fever (54.1%), cough (50.9%), and dyspnea (37.2%); 14.2% were asymptomatic. There were 139 deaths (18.8%), with 66% within the disease's first 15 days. 333 patients (44.9%) required hospitalization, and 211 (28.5%) were admitted to an intensive care unit. The cumulative probability of survival at 90 days of diagnosis was 79% (95% CI 76-82%). In the fully adjusted multivariate model, the risk factors significantly associated with death were diabetes mellitus (HR 1.52, 95% CI 1.05-2.19, P = 0.026), use of a central venous catheter (CVC) (HR 1.79, 95% CI 1.22-2.64, P = 0.003), age (HR 1.03, 95% CI 1.01-1.04, P < 0.001), and origin from the North vs. Southeast region (HR 2.60, 95% CI 1.01-6.68, P = 0.047). CONCLUSIONS Hemodialysis patients using a CVC as the vascular access, aside from diabetic and elderly ones, should be closely monitored due to their high risk of death in the course of the COVID-19.
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Affiliation(s)
| | | | - Andrea Pio-Abreu
- Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, SP, Brazil
| | | | - Ricardo Sesso
- Division of Nephrology, Escola Paulista de Medicina, Federal University of São Paulo, Rua Botucatu 740, São Paulo, SP, 04023-900, Brazil.
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Barros FS, Pinheiro BV, Lucinda LMF, Rezende GF, Segura-Ortí E, Reboredo MM. Exercise training during hemodialysis in Brazil: A national survey. Artif Organs 2021; 45:1368-1376. [PMID: 34153118 DOI: 10.1111/aor.14018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/03/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
To evaluate the availability and characteristics of exercise training during hemodialysis in Brazil and to identify the reported barriers to exercise program implementation and maintenance. All dialysis units were assessed for eligibility using the database of the Brazilian Society of Nephrology. Each dialysis unit was contacted by telephone and the questions were administered. In dialysis units with exercise training, questions related to personnel involved, exercise components, and program delivery were included. Additionally, the barriers to exercise program implementation and maintenance were evaluated. This study included 261 dialysis units that responded to the survey. Forty-one dialysis units reported exercise training during hemodialysis in Brazil (prevalence of 15.7%). We identified 66 physiotherapists and 10 exercise physiologists in dialysis units with exercise training. Resistance training was the most common program component (92.7%). Hypotension (90.5%) and muscle cramps (85.7%) were the most common adverse events reported. In dialysis units with exercise training, poor patients' adherence to exercise was the most commonly reported barrier. The most prevalent barrier in dialysis units that tried or never tried to implement the exercise programs was a lack of resources. The number of dialysis units that have exercise training during hemodialysis in Brazil is low, and the most common program component is resistance training. A lack of resources was the most prevalent barrier in dialysis units that tried or never tried to implement the exercise programs.
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Affiliation(s)
- Fabrício Sciammarella Barros
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Bruno Valle Pinheiro
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil.,School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Leda Marília Fonseca Lucinda
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Gabriel Ferreira Rezende
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Eva Segura-Ortí
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Maycon Moura Reboredo
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil.,School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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Lopes MB. Brazilian Nephrology Census 2019: a guide to assess the quality and scope of renal replacement therapy in Brazil. How are we, and how can we improve? J Bras Nefrol 2021; 43:154-155. [PMID: 34174065 PMCID: PMC8257278 DOI: 10.1590/2175-8239-jbn-2021-e006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/27/2021] [Indexed: 11/21/2022] Open
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Araújo Rocha G, Lima de Oliveira AK, Lima Oliveira FG, Silva Rodrigues VE, de Sousa Moura AG, Barros Sousa E, Gomes Machado AL. Cuidados com o acesso vascular para hemodiálise: revisão integrativa. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.2090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introdução: As complicações relacionadas ao acesso vascular para hemodiálise podem resultar em intervenções complexas, contudo, cuidados adotados pelos profissionais de saúde e pacientes adultos podem evitá-las. Objetivou-se analisar a produção científica acerca dos cuidados com acessos vasculares utilizados na hemodiálise para elaboração do conteúdo de uma cartilha educativa voltada ao autocuidado do paciente. Método: Revisão integrativa de literatura realizada nas bases de dados: LILACS, PUBMED, BDENF, SciELO e CINAHL. A busca dos estudos deu-se entre setembro e novembro de 2019, nos idiomas português, inglês ou espanhol, utilizando os termos dos DeCS e MeSH. A seleção dos artigos foi realizada por três pesquisadores e foram extraídas informações: país, ano de publicação, delineamento do estudo, número de pacientes, intervenções, desfechos e nível de evidência científica. Selecionaram-se 10 artigos processados no software IRAMUTEQ® e analisados descritivamente pelo modelo de Reinert. Resultados: Organizaram-se sete classes: Cuidados com o cateter após a hemodiálise; Cuidados com a FAV antes da hemodiálise; Cuidados com a FAV após a hemodiálise; Cuidados para evitar a interrupção do funcionamento da FAV; Autocuidado dos pacientes com a FAV; Cuidados realizados pela equipe de enfermagem; Conhecimento do paciente acerca dos cuidados com a pele e punção da FAV. Conclusão: Identificou-se que os cuidados com os acessos vasculares mais frequentes se relacionam com a fístula arteriovenosa, demonstrando sua grande representatividade no tratamento do paciente com doença renal crônica. A síntese do conhecimento proporcionada nesta revisão foi utilizada para a elaboração de uma cartilha educativa já validada por especialistas e por pacientes que realizam hemodiálise.
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