Scielo RSS http://scielo.pt/rss.php?pid=0872-016920210002&lang=es vol. 35 num. 2 lang. es http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692021000200069&lng=es&nrm=iso&tlng=es ABSTRACT Peritoneal dialysis (PD) relies on adequate function of PD catheter. Mechanical complications are a major cause of dropout among PD patients. A prompt timing and an appropriate intervention may overcome these problems with catheter salvage, without interrupting PD treatment. Many Portuguese centers still lack a proper articulation between nephrology and surgical departments. We describe current available surgical approaches in the implantation of PD catheters, management of mechanical complications, exit‑site infections and other abdominal surgical procedures. Our aim is to reinforce the need for an established protocol of action between these departments as occurs with vascular access in hemodialysis. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692021000200082&lng=es&nrm=iso&tlng=es ABSTRACT Peritoneal dialysis (PD) relies on adequate function of PD catheter. Mechanical complications are a major cause of dropout among PD patients. A prompt timing and an appropriate intervention may overcome these problems with catheter salvage, without interrupting PD treatment. Many Portuguese centers still lack a proper articulation between nephrology and surgical departments. We describe current available surgical approaches in the implantation of PD catheters, management of mechanical complications, exit‑site infections and other abdominal surgical procedures. Our aim is to reinforce the need for an established protocol of action between these departments as occurs with vascular access in hemodialysis. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692021000200084&lng=es&nrm=iso&tlng=es ABSTRACT Chronic kidney disease is an increasingly common diagnosis in the very elderly and identifying the patients who benefit from a nephrologist’s intervention and the ones who would not might avoid wasteful or harmful interventions. The aim of this study is to identify the risk factos for progressive versus non‑progressive chronic kidney disease in a population aged over 80 years old. We performed a cohort single‑center retrospective study including 101 patients over 80 years old with chronic kidney disease diagnosed for at least five years and followed regularly by a nephrologist. Progressive disease was defined as glomerular filtration rate declines greater than 5 mL/min/1.73 m2/year. Of the 101 patients, 33.7% had progressive chronic kidney disease. The median glomerular filtration progression rate was 3.0 [2.1‑6.0] mL/min/1.73m2/year. Hypertension and diabetes mellitus prevalence was similar between groups. Nephrology follow‑up time was longer in the progressive group (5.0 vs 2.0 years, p=0.01). Regarding chronic kidney disease complications, 37.6% had anemia and half of these needed erythropoiesis‑stimulating agents. None of the patients had hyperphosphatemia. About 18.8% presented metabolic acidosis. In multivariable analysis, after adjusting for covariables such as age, hypertension, and diabetes mellitus only the presence of metabolic acidosis (OR 0.4, CI: 0.1‑0.8) was associated with the development of progressive chronic kidney disease. Progressive chronic kidney disease group presented higher mortality (log rank 4.5, p=0.03). Ischemic cardiomyopathy (OR: 0.5, CI: 0.2‑0.9) and progressive chronic kidney disease (OR: 0.6, CI:0.3‑0.8) were associated with all‑cause mortality. Our results showed that most elderly patients have non‑progressive chronic kidney disease. Patients with metabolic acidosis seem to be at an increased risk for developing progressive disease. Most elderly patients die before reaching end‑stage kidney disease, so it is importante to look at progressive kidney disease in those patients as an important marker of comorbidity and privilege cardioprotective measures. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692021000200089&lng=es&nrm=iso&tlng=es ABSTRACT In Portugal, as well as in Europe, peritoneal dialysis (PD) use remains low. Reorganization of PD units including a well‑structured peritoneal access management protocol are fundamental to improve the take‑up of this therapy. We analyzed the procedure and outcomes in a PD unit, addressing two key quality questions: at which level of estimated glomerular filtration rate (eGFR) were patients referred to peritoneal cateter placement and whether if it was timely placed. We retrospectively evaluated all patients submitted to catheter placement between 2017 and June 2020. We analyzed the patient journey from Kidney Replacement Therapies (KRT) Option Appointment, until PD start, as well as demographic and clinical variables, including eGFR at four time points (KRT Options Appointment, PD unit evaluation, catheter placement, and PD start). To explore the adequacy of cateter placement schedule, we compared the characteristics of the patients who started PD within 90 days of catheter placement (Early group), and of those who started after the first 90 days (Late group). We analyzed 48 patients in the Early and 27 in the Late group. The Early group presented a lower eGFR on KRT Options Appointment, with timely intervention: eGFR at catheter placement averaged 8.0 ± 2.1 mL/min/1,72m2. PD start occurred at 7.0 ± 1.9 and 8.0 ± 2.4 mL/min/1.72m2, in the Early and Late group, respectively. None of the patients suffered an urgent transition to HD by CVC. Four patients started PD less than 15 days after catheter placement, all of them without complications. PD patients’ admission involves specific tasks. Administrative tools or indicators to evaluate those processes are lacking. A peritoneal access clinic would allow the formalization of this circuit, allowing a quality and equitable approach to dialysis access. We suggest a structured pathway for peritoneal access management. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692021000200093&lng=es&nrm=iso&tlng=es ABSTRACT Coronavirus disease 2019 (COVID-19) has affected millions worldwide, and in particular the care of patients on maintenance hemodialysis. These patients are thought to be at high risk of severe SARS-CoV-2 infection due to their older age and multiple comorbidities. The aim of this study was to compare hemodialysis and non-dialysis COVID-19 patients and find possible risk factors for mortality in hemodialysis patients. We developed a single-center retrospective cohort study, from March 1st to December 31st, 2020, that included maintenance hemodialysis patients hospitalized with laboratory confirmed SARS-CoV-2 infection, and age and sex propensity matched non-dialysis patients also hospitalized with a laboratory confirmed SARS-CoV-2 infection (1:1). A total of 34 hemodialysis patients were included, 70.6% male, mean age 76.5 years and on maintenance hemodialysis for 3.0 [0.5-23] years. At admission, 50.0% needed oxygen supply. Median hospital stay duration was 11.0 [5.8-17.0] days, and 38.2% developed bacterial superinfection. Maintenance hemodialysis patient mortality rate was 32.4%. When matched to the non-dialysis group, the hemodialysis group developed more often respiratory insufficiency (50.0% vs 8.8%, p<0.001) and had higher ferritin (1658.0 vs 623.5, p=0.004) and troponin T (130.0 vs 31.0, p<0.001) levels, whereas the non-dialysis group had higher transaminases levels. There was no statistical difference regarding hospitalization time, bacterial superinfection, or mortality between groups. When the logistic regression was performed, only bacterial superinfection was a predictor for mortality in hemodialysis COVID-19 patients (0.01 [0.00-0.26]). There was no difference in hospital stay nor in death rate between hemodialysis and non-dialysis COVID-19 patients. Despite these results, we must emphasize that mortality in the dialysis group was particularly high, with up to 32% of in-hospital mortality, and that bacterial superinfection has been shown to be an independent predictor of mortality. These results highlight the importance of interventions, such as full vaccination coverage, to mitigate the burden of COVID-19 in hemodialysis patients. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692021000200099&lng=es&nrm=iso&tlng=es ABSTRACT Sarcopenia is a progressive age‑related loss of muscle mass associated with a decline in muscle function and physical performance. Patients with chronic kidney disease experience substantial loss of muscle mass, weakness, and poor physical performance. Indeed, with the progression of chronic kidney disease, skeletal muscle dysfunction contributes to mobility limitation, loss of functional independence, and vulnerability to disease complications. There is a lack of robust data on the negative effect of the impact of kidney disease on skeletal muscle dysfunction, as well as on screening and treatment strategies that can be used in clinical practice to prevent functional decline and disability. Therefore, sarcopenia may be na underestimated condition with major implications for people with chronic kidney disease, even before the start of dialysis, which makes research into this topic necessary. The purpose of this review is to expand on some fundamental topics of sarcopenia, with an emphasis on the setting of chronic kidney disease patients. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692021000200106&lng=es&nrm=iso&tlng=es ABSTRACT Arteriovenous fistulas (AVFs) are the first-choice vascular access for most HD patients. Up to 60% of AVFs do not mature adequately, mostly due to stenosis. Surgical and endovascular techniques can rescue up to 80% of these AVFs from primary failure, allowing them to be safely and effectively used in HD, preserving venous capital, and avoiding placement of CVCs and associated complications. This article reviews and summarizes the existing literature, offering a practical approach on early identification, treatment, and monitoring of immature AVFs. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692021000200111&lng=es&nrm=iso&tlng=es ABSTRACT Chronic kidney disease - mineral and bone disorders (CKD‑MBD) tends to improve or to change phenotypically in the post‑transplant period. Mineral and bone disorders post‑transplantation (MBD‑PT) seem to be associated with high fracture risk and cardiovascular morbidity, and so it is necessary to be aware of its presence to minimize the MBD‑PT impact. In this article we summarize the features of MBD‑PT. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692021000200114&lng=es&nrm=iso&tlng=es ABSTRACT Peritonitis is a serious complication in peritoneal dialysis, usually secondary to an infectious cause. Chemical peritonitis is rarer. No case exclusively attributed to vancomycin has been reported in the last 20 years. Data from 4 consecutive patients diagnosed with culture‑negative peritonitis following administration of intraperitoneal vancomycin between May and June 2019 were retrospectively recorded. All patients were treated with 2 grams of intraperitoneal vancomycin after a break in aseptic technique and developed a cloudy effluent. No patient was previously known to be allergic to vancomycin. All had a clear dialysate before vancomycin. All developed an elevated leukocyte count in the dialysate. All had sterile cultures. All resumed a clear effluent with less <100 cells/μL after vancomycin cessation, and in two there were no further administrations. In one, a new drug challenge led to recrudescence of abdominal pain and reappearance of a cloudy sterile effluent. In another, vancomycin from a different lot was administrated 3 days after, no symptoms developed and dialysate cell count remained normal. The pathogenic mechanisms underlying chemical peritonitis are not fully known. The clinical course is typically benign. Management seems to be limited to drug withdrawal. If unrecognized, chemical peritonitis may ultimately lead to unnecessary catheter removal. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692021000200118&lng=es&nrm=iso&tlng=es ABSTRACT Eosinophilic granulomatosis with polyangiitis is an ANCA vasculitis characterized by asthma, rhinosinusitis and peripheral eosinophilia. The kidney is infrequently involved, usually in the form of necrotizing crescentic glomerulonephritis. We present the case of a 60-year-old man who presented with painless sudden loss of visual acuity, purpuric exanthem in his legs, asthenia and myalgia. CT-scan ruled out acute vascular and intracranial space occupant lesions. Optical coherence tomography showed signs of left central retinal artery occlusion and perfusion deficits in the right arterial retinal blood supply. Complementary study showed prominent peripheral eosinophilia (24.500 cel/uL), increased serum IgE (1260U/L) and increased C-reactive protein (10.6mg/dl). During admission, the patient presented with acute kidney failure (serum creatinine of 4.7mg/dl) and an exceptionally high p-ANCA MPO titer (>600U/L). Eosinophilic granulomatosis with polyangiitis was diagnosed and plasmapheresis, pulse steroid therapy and intravenous cyclophosphamide were provided. Kidney biopsy showed interstitial nephritis with high eosinophil content while the glomerulus was relatively spared, with only mild endocapillary proliferation. The patient didn’t require dialysis. Kidney function was normal at discharge, although the visual deficit did not improve. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692021000200123&lng=es&nrm=iso&tlng=es ABSTRACT Severe hypercalcemia can be either acute or decompensate from a chronic state to a medical emergency, the hypercalcemic crisis. The presence of symptoms such as altered mental status or potentially fatal ECG abnormalities demand an expeditious decrease in serum calcium levels. Standard medical therapy consists of vigorous volume replacement, calcitonin and, depending on the etiology, bisphosphonates, cinacalcet or glucocorticoids. Hypercalcemic crisis is a rare indication for urgent hemodialysis and is reserved for patients with severe symptoms, ineffective medical therapy or end stage renal disease. The use of hemodialysis in this scenario is not commonly reported. We hereby report a patient who presented with altered mental status and acute kidney injury due to a hypercalcemic crisis secondary to primary hyperparathyroidism. Treatment included urgent hemodialysis to effectively lower calcium levels. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692021000200128&lng=es&nrm=iso&tlng=es ABSTRACT Severe hypercalcemia can be either acute or decompensate from a chronic state to a medical emergency, the hypercalcemic crisis. The presence of symptoms such as altered mental status or potentially fatal ECG abnormalities demand an expeditious decrease in serum calcium levels. Standard medical therapy consists of vigorous volume replacement, calcitonin and, depending on the etiology, bisphosphonates, cinacalcet or glucocorticoids. Hypercalcemic crisis is a rare indication for urgent hemodialysis and is reserved for patients with severe symptoms, ineffective medical therapy or end stage renal disease. The use of hemodialysis in this scenario is not commonly reported. We hereby report a patient who presented with altered mental status and acute kidney injury due to a hypercalcemic crisis secondary to primary hyperparathyroidism. Treatment included urgent hemodialysis to effectively lower calcium levels.