Epidemiological profile of acute kidney injury in critically ill patients admitted to intensive care units : a prospective brazilian cohort

Introdução: A injúria renal aguda (IRA) é uma síndrome frequente em pacientes admitidos em unidades de terapia intensiva (UTI) e está associada a negativos desfechos clínicos. O objetivo do presente estudo foi conhecer o perfil epidemiológico de pacientes com IRA admitidos em UTIs. Métodos: Estudo de coorte prospectiva, realizado em três UTIs do Distrito Federal, Brasil. Entre o período de outubro/2017 e dezembro/2018, 8.131 pacientes foram incluídos na coorte. A IRA foi definida de acordo com o critério KDIGO. Os principais desfechos avaliados foram o desenvolvimento de IRA e mortalidade dentro de 28 dias de internação. Resultados: Dos 8.131 pacientes acompanhados, 1.728 desenvolveram IRA (21,3%). Dos 1.728 pacientes com IRA, 1.060 (61,3%) desenvolveram o estágio 1, já os estágios 2 e 3 representaram 154 (8,9%) e 514 (29,7%), respectivamente. Destes, um total de 459 (26,6%) realizou terapia renal substitutiva. A mortalidade observada foi de 25,7% para aqueles com IRA e 4,9% para os não IRA. Discussão: Os pacientes com IRA, comparados aos não IRA, apresentaram maior mortalidade. Da mesma forma, entre os pacientes com IRA, os estágios superiores estiveram associados à maior ocorrência de óbito. A incidência de IRA (21,3%) e mortalidade (25,7%) em nosso estudo está em consonância com a maior meta-análise já conduzida, na qual foram observadas incidência e mortalidade de 21,6 e 23,9%, respectivamente. Esses achados confirmam a importância de se estabelecer a diretriz KDIGO para definição e manejo da IRA em UTIs brasileiras.Introduction: Acute kidney injury (AKI) is a frequent syndrome affecting patients admitted to intensive care units (ICU), and it is associated with poor clinical outcomes. The aim of the present study was to understand the epidemiological profile of patients with AKI admitted to ICUs. Methods: Prospective cohort study, carried out in three ICUs in the Federal District, Brazil. Between October/2017 and December/2018, 8,131 patients were included in the cohort. AKI was defined according to the KDIGO criteria. The main outcomes assessed were AKI development and mortality within 28 days of hospitalization. Results: Of the 8,131 patients followed up, 1,728 developed AKI (21.3%). Of the 1,728 patients with AKI, 1,060 (61.3%) developed stage 1, while stages 2 and 3 represented 154 (8.9%) and 514 (29.7%), respectively. Of these, 459 (26.6%) underwent renal replacement therapy. The mortality was 25.7% for those with AKI, and 4.9% for those without AKI. Discussion: Patients with AKI had higher mortality rates when compared to those without AKI. Likewise, among patients with AKI, higher disease stages were associated with higher death occurrences. AKI incidence (21.3%) and mortality (25.7%) in our study is in line with the largest meta-analysis ever conducted, in which incidence and mortality of 21.6 and 23.9% were observed, respectively. These findings confirm the importance of establishing the KDIGO guideline for the definition and management of AKI in Brazilian ICUs

Perfil do sono de pacientes em hemodiálise: um estudo transversal no Distrito Federal

Objetivo: Avaliar o perfil do sono de pacientes em hemodiálise (HD). Métodos: Estudo transversal com pacientes em hemodiálise de duas clínicas no Distrito Federal, Brasil. Durante a sessão de HD houve a aplicações dos questionários de Índice de Qualidade de Sono de Pittsburgh e Escala de Sonolência de Epworth. Resultados: Foram incluídos 65 pacientes (56,9% homens e 61,4 ± 16,4 anos). Os resultados demonstraram qualidade do sono irregular em 57,6% da amostra. A presença de sonolência diurna excessiva compreendeu 34,6% dos pacientes. Conclusão: Nossos achados mostram um perfil do sono prejudicado em pacientes em HD, evidenciando um preocupante cenário, que pode ser avaliado e identificado com facilidade por meio de instrumentos de rastreio

Post-COVID-19 rehabilitation: a special look at chronic kidney disease patients

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect the kidney and the presence of chronic kidney disease (CKD) constitutes a higher risk of negative prognosis. SARS-CoV-2 main sequelae in CKD patients are an incomplete recovery of kidney function, muscle weakness and atrophy, breathiness, tiredness, pulmonary fibrosis, and initiation of kidney replacement therapy. The overall aim of this review is to provide a theoretical basis for early improvements of physical function health to all CKD stages by rehabilitation therapies. Conclusion Chronic kidney disease patients infected with SARS-CoV-2 should be monitored by rehabilitation professionals as the cardiopulmonary, musculoskeletal, and cognitive systems might be deteriorated. Long-term consequences of SARS-CoV-2 are unknown and preventive rehabilitation may attenuate them

Design and methodology of the SARCopenia trajectories and associations with adverse clinical outcomes in patients on HemoDialysis: the SARC-HD study

Abstract Background Sarcopenia has been associated with adverse outcomes in patients with chronic kidney disease (CKD), particularly in those undergoing hemodialysis (HD). However, the trajectories across sarcopenia stages, their determinants, and associations with adverse clinical outcomes have yet to be comprehensively examined. Methods The SARC-HD is a multicenter, observational prospective cohort study designed to comprehensively investigate sarcopenia in patients on HD. Eligibility criteria include adult patients undergoing HD for ≥ 3 months. The primary objective is to investigate the trajectories of sarcopenia stages and their potential determinants. Secondary objectives include evaluating the association between sarcopenia and adverse clinical outcomes (i.e., falls, hospitalization, and mortality). Sarcopenia risk will be assessed by the SARC-F and SARC-CalF questionnaire. Sarcopenia traits (i.e., low muscle strength, low muscle mass, and low physical performance) will be defined according to the revised European Working Group on Sarcopenia in Older People and will be assessed at baseline and after 12 follow-up months. Patients will be followed-up at 3 monthly intervals for adverse clinical outcomes during 24 months. Discussion Collectively, we expect to provide relevant clinical findings for healthcare professionals from nephrology on the association between sarcopenia screening tools (i.e., SARC-F and SARC-CalF) with objective sarcopenia measurements, as well as to investigate predictors of trajectories across sarcopenia stages, and the impact of sarcopenia on adverse clinical outcomes. Hence, our ambition is that the data acquired from SARC-HD study will provide novel and valuable evidence to support an adequate screening and management of sarcopenia in patients on HD

Intradialytic isometric handgrip exercise does not cause hemodynamic instability: A randomized, cross‐over , pilot study

Hemodialysis (HD) patients experience hemodynamic instability and intradialytic exercise seems to attenuate it. This study aimed to verify the acute hemodynamic response to different intradialytic handgrip exercise intensities in HD patients. In a randomized, cross-over, experimental pilot study, eight patients completed two experimental sessions and one control in random order: (a) regular HD; (b) low-intensity isometric handgrip exercise; and (c) moderate-intensity isometric handgrip exercise. BP and heart rate variability were recorded immediately before and every 15 minutes. Isometric handgrip exercise protocols, regardless of the intensity, did not lead to significant changes in hemodynamic stability, nor when compared to the control condition (P > .05). The systolic BP and double product significantly increased immediately after the moderate-intensity protocol (122.0 ± 15.9 vs 131.3 ± 19.8, P < .05; 9094.7 ± 1705.7 vs 9783.0 ± 1947.9, P < .05, respectively) but returned to the pre-exercise values 10 minutes later. We conclude that intradialytic isometric handgrip exercise does not induce hemodynamic instability at low and moderate intensities.info:eu-repo/semantics/publishedVersio