Prognostic role of renal replacement therapy among hospitalized patients with heart failure in the Brazilian national public health system

IntroductionData on patients hospitalized with acute heart failure in Brazil scarce.MethodsWe performed a cross-sectional, retrospective, records-based study using data retrieved from a large public database of heart failure admissions to any hospital from the Brazilian National Public Health System (SUS) (SUS Hospital Information System [SIHSUS] registry) to determine the in-hospital all-cause mortality rate, in-hospital renal replacement therapy rate and its association with outcome.ResultsIn total, 910,128 hospitalizations due to heart failure were identified in the SIHSUS registry between April 2017 and August 2021, of which 106,383 (11.7%) resulted in in-hospital death. Renal replacement therapy (required by 8,179 non-survivors [7.7%] and 11,496 survivors [1.4%, p < 0.001]) was associated with a 56% increase in the risk of death in the univariate regression model (HR 1.56, 95% CI 1.52 -1.59), a more than threefold increase of the duration of hospitalization, and a 45% or greater increase of cost per day. All forms of renal replacement therapy remained independently associated with in-hospital mortality in multivariable analysis (intermittent hemodialysis: HR 1.64, 95% CI 1.60 -1.69; continuous hemodialysis: HR 1.52, 95% CI 1.42 -1.63; peritoneal dialysis: HR 1.47, 95% CI 1.20 -1.88).DiscussionThe in-hospital mortality rate of 11.7% observed among patients with acute heart failure admitted to Brazilian public hospitals was alarmingly high, exceeding that of patients admitted to North American and European institutions. This is the first report to quantify the rate of renal replacement therapy in patients hospitalized with acute heart failure in Brazil

Microangiopatia Trombótica Pós-Transplante Renal: Características Clínico-Histológicas E Prognóstico Do Enxerto Renal

Objective: To Assess The Incidence, Clinical And Histological Features And Prognosis Of Kidney Or Kidney-Pancreas Transplanted Patients With Thrombotic Microangiopathy (Tma). Methods: We Retrospectively Studied Data Of 89 Patients With Post-Transplant Tma, Which Was Characterized By Thrombi In At Least One Glomerulus And/Or Arteriole. Systemic Tma Was Defined By Thrombocytopenia And Microangiopathic Anemia And Early Onset Tma, When Occurred Less Than 90 Days Post Transplant. Lesions Were Classified According To Thrombi Location And Pattern Of Injury (With Or Without Endothelial Cell Activation). Results: The Cumulative Incidence Was 0.93%. The Majority Of The Recipients Were Young (Mean Age 39 Years), Female (52%) And Caucasian (48%) With Primary Kidney Disease Of Unknown Etiology (37%). Early Tma Occurred In 51% Of The Patients And Systemic Tma, In 25%. The Causes Of Tma Were Infection (34%), Acute Rejection (16%), Calcineurin Inhibitor Toxicity (13%), Tma Recurrence (2%) And Pregnancy (1%). 18% Of The PatieObjetivo: Relatar A Incidência, Características Clínico-Histológicas E Prognóstico Do Enxerto Dos Casos De Microangiopatia Trombótica (Mat) No Enxerto Renal Entre Receptores De Transplante Renal E Pâncreas-Rim Do Hospital Do Rim. Métodos: Foram Estudados Retrospectivamente Dados De 89 Pacientes Com Mat Pós-Transplante, Que Foi Caracterizada Pela Presença De Trombos Em, Pelo Menos, Um Glomérulo E/Ou Arteríola. Mat Sistêmica Foi Definida Por Trombocitopenia E Anemia Microangiopática; E Mat De Início Precoce Quando Ocorreu Com Menos De 90 Dias Após O Transplante. As Lesões Foram Classificadas De Acordo Com A Localização Do Trombo E O Padrão Histológico (Com Ou Sem Ativação Das Células Endoteliais). Resultados: A Incidência Cumulativa Foi De 0,93%. A Maioria Dos Receptores Era Jovem (Média De 39 Anos), Do Sexo Feminino (52%), Caucasiana (48%) E Com Doença Renal Primária De Etiologia Desconhecida (37%). Mat Precoce Ocorreu Em 51% Dos Pacientes E Mat Sistêmica Em 25%. As Etiologias Da Mat Foram: Infecção (34%), RejDados abertos - Sucupira - Teses e dissertações (2018