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Abstract Introduction: Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality. Methods: Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant. Results: A total of 150 patients were included, with a median age of 93.0 years (91.2-95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04-0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17-8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03-49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98-16.85, p = 0.001) were associated with mortality. Conclusion: AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death.

Resumo Introdução: Nonagenários constituem um percentual de pacientes internados em ascensão, sendo a injúria renal aguda (IRA) frequente nesses pacientes. Sendo assim, é importante analisar as características clínicas dessa população e seu impacto na mortalidade. Métodos: Estudo retrospectivo de pacientes nonagenários com IRA entre 2013 e 2022 em um hospital terciário. Apenas o último internamento foi considerado e pacientes com dados incompletos foram excluídos. Uma análise por regressão logística foi realizada para definir fatores de risco para mortalidade. Um valor de p < 0,05 foi considerado significativo. Resultados: Foram incluídos 150 pacientes com mediana de idade 93,0 anos (91,2-95,0) e sexo masculino em 42,7%. Sepse foi a causa mais comum de IRA (53,3%), seguida de desidratação/hipovolemia (17,7%) e insuficiência cardíaca (17,7%). Admissão na UTI ocorreu em 39,3% dos pacientes, ventilação mecânica em 14,7%, uso de vasopressores em 22,7% e realização de terapia renal substitutiva (TRS) em 6,7%. Óbito ocorreu em 56,7% dos pacientes. Desidratação/hipovolemia como etiologia da IRA foi associado a menor risco de mortalidade (OR 0,18; IC 95% 0,04-0,77, p = 0,020). Estágio KDIGO 3 (OR 3,15; IC 95% 1,17-8,47, p = 0,023), admissão na UTI (OR 12,27; IC 95% 3,03-49,74, p < 0,001) e oligúria (OR 5,77; IC 95% 1,98-16,85, p = 0,001) foram associados à mortalidade. Conclusão: Nonagenários com IRA apresentaram alta mortalidade e IRA KDIGO 3, oligúria e admissão na UTI foram associadas ao óbito.

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INTRODUCTION: Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality. METHODS: Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant. RESULTS: A total of 150 patients were included, with a median age of 93.0 years (91.2-95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04-0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17-8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03-49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98-16.85, p = 0.001) were associated with mortality. CONCLUSION: AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death.

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Introduction: Central venous catheters for hemodialysis (HD) can be nontunneled catheters (NTC) or tunneled catheters (TC). Bacteremia and dysfunction are complications that can impact morbidity and mortality. We decided to compare the rates of bacteremia and dysfunction between NTC and TC and patient survival 90 days after catheter insertion. Methods: Retrospective cohort to evaluate catheters inserted between January 2011 and December 2020 in a tertiary hospital. Catheters in patients with end-stage chronic kidney disease were included. Patients with acute kidney injury, catheters that lasted less than three HD sessions, and patients who died within one week after insertion were excluded. Bacteremia and dysfunction rates, bacteremia-free survival, and dysfunction-free survival were investigated. Multivariable analysis was performed using a Cox proportional hazards regression model for patient survival at 90 days. Results: 670 catheters were analyzed in 287 patients, 422 NTC (63%), and 248 TC (37%). The rates of confirmed bacteremia per 1,000 catheter-days were 1.19 for NTC and 0.20 for TC (p < 0.0001). The confirmed or possible bacteremia rates were 2.27 and 0.37 per 1,000 catheter-days for NTC and TC, respectively (p < 0.0001). The dysfunction rates were 3.96 and 0.86 for NTC and TC, respectively (p < 0.0001). Patient survival at 90 days was higher in the TC group than the NTC group (96.8% vs. 89.1%; p < 0.0001). Conclusion: We found lower rates of bacteremia and dysfunction for TC and demonstrated that using NTC affects patient mortality.

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ABSTRACT Introduction: Acute Kidney Injury (AKI), a frequent manifestation in COVID-19, can compromise kidney function in the long term. We evaluated renal function after hospital discharge of patients who developed AKI associated with COVID-19. Methods: This is an ambidirectional cohort. eGFR and microalbuminuria were reassessed after hospital discharge (T1) in patients who developed AKI due to COVID-19, comparing the values with hospitalization data (T0). P < 0.05 was considered statistically significant. Results: After an average of 16.3 ± 3.5 months, 20 patients were reassessed. There was a median reduction of 11.5 (IQR: -21; -2.1) mL/min/1.73m2 per year in eGFR. Forty-five percent of patients had CKD at T1, were older, and had been hospitalized longer; this correlated negatively with eGFR at T1. Microalbuminuria was positively correlated with CRP at T0 and with a drop in eGFR, as well as eGFR at admission with eGFR at T1. Conclusion: There was a significant reduction in eGFR after AKI due to COVID-19, being associated with age, length of hospital stay, CRP, and need for hemodialysis.

RESUMO Introdução: A Injúria Renal Aguda (IRA), uma manifestação frequente na COVID-19, pode comprometer a função renal em longo prazo. Avaliamos a função renal após a alta hospitalar de pacientes que desenvolveram IRA associada à COVID-19. Métodos: Esta é uma coorte ambidirecional. A TFGe e a microalbuminúria foram reavaliadas após a alta hospitalar (T1) em pacientes que desenvolveram IRA devido à COVID-19, comparando os valores com dados de hospitalização (T0). P < 0,05 foi considerado estatisticamente significativo. Resultados: Após uma média de 16,3 ± 3,5 meses, 20 pacientes foram reavaliados. Houve uma redução média de 11,5 (IIQ: -21; -2,1) mL/min/1,73m2 por ano na TFGe. Quarenta e cinco por cento dos pacientes apresentaram DRC no T1, eram mais velhos e haviam sido hospitalizados por mais tempo; isso se correlacionou negativamente com a TFGe no T1. A microalbuminúria foi positivamente correlacionada com a PCR no T0 e com uma queda na TFGe, assim como a TFGe na admissão com a TFGe no T1. Conclusão: Houve uma redução significativa na TFGe após IRA devido à COVID-19, sendo associada à idade, tempo de internação, PCR e necessidade de hemodiálise.

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INTRODUCTION: Acute Kidney Injury (AKI), a frequent manifestation in COVID-19, can compromise kidney function in the long term. We evaluated renal function after hospital discharge of patients who developed AKI associated with COVID-19. METHODS: This is an ambidirectional cohort. eGFR and microalbuminuria were reassessed after hospital discharge (T1) in patients who developed AKI due to COVID-19, comparing the values with hospitalization data (T0). P < 0.05 was considered statistically significant. RESULTS: After an average of 16.3 ± 3.5 months, 20 patients were reassessed. There was a median reduction of 11.5 (IQR: -21; -2.1) mL/min/1.73m2 per year in eGFR. Forty-five percent of patients had CKD at T1, were older, and had been hospitalized longer; this correlated negatively with eGFR at T1. Microalbuminuria was positively correlated with CRP at T0 and with a drop in eGFR, as well as eGFR at admission with eGFR at T1. CONCLUSION: There was a significant reduction in eGFR after AKI due to COVID-19, being associated with age, length of hospital stay, CRP, and need for hemodialysis.

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BACKGROUND: Catheter implantation techniques for peritoneal dialysis (PD) have advanced significantly in recent years. We aimed to analyze the survival and associated complications of catheters inserted using a new technique that is guided by ultrasound and fluoroscopy and requires minimal tissue dissection. The procedure was performed by nephrologists in the outpatient basis, we compared these results of the minimally invasive insertion with traditional implantation using trocars. METHODS: A total of 152 PD catheters were placed in 152 patients with stage 5 chronic kidney disease; 62.5% of the patients were men, with a mean age of 56.6 ± 18.5 years. The following two methods were used: minimally invasive insertion (MI group, n = 73) and trocar insertion (T group, n = 79). Patients in both the groups were followed prospectively for 26 months from the date of the first implantation. RESULTS: Gender, age, and prevalence of diabetes mellitus were not significantly different between the groups, while the body mass index, presence of obesity, and abdominal scars from previous surgeries were higher in the MI group (p = 0.021). The incidence of catheter dysfunction was lower in the MI group compared to group T (6.8% vs 20.3%; p = 0.019). Exit site infection was also lower with the new technique (4.1% vs. 18.9%; p = 0.005). Further, the cumulative incidence of peritonitis also reduced with MI (p = 0.034). Finally, the overall catheter survival at 1 year was 89%, which has been shown as higher in group MI (95% vs 82% in group T; p = 0.025). CONCLUSION: The MI technique for catheter insertion showed low complication rates and excellent catheter survival as compared to traditional implantation methods; thus, it may be an alternative method for PD catheter placement.

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In Brazil, most hemodialysis (HD) patients are treated by the country's public health system. However, accessibility to healthcare is different for public and private patients. This study aimed to identify the profile of vascular access in a Brazilian HD sample. Additionally, it aimed to examine the influence of public and private health insurance, accessibility to endovascular treatments, and timely arteriovenous access creation on the prevalence of tunneled catheters (TCs), non-tunneled catheters (NTCs), and arteriovenous (AV) access. We conducted a cross-sectional electronic survey across 834 centers. Centers were inquired about the number of patients with public and private health insurance, the profiles of vascular access, time for AV access creation, accessibility to TC insertion and endovascular treatments, and the availability of peritoneal dialysis and kidney transplantation. Logistic regression and multilevel logistic regression were performed to evaluate possible interactions between the independent variables. A total of 7,973 patients across 47 HD centers were included in the survey. Public health patients accounted for 77% of the study sample. The overall vascular access profiles of the public and private insurance groups were significantly different (p < 0.001). For patients with public health insurance, the prevalence of any catheter was 25%, while that for private patients was 31.8% (p < 0.001). The prevalence of TCs was more common in private patients (15.3% vs. 23.1%, p < 0.001). AV accesses were more common in public health patients (75% vs. 68.2%, p < 0.001), as were fistulas (72.4% vs. 63.1%, p < 0.001). AV grafts were more prevalent among patients with private insurance (2.6 vs. 5.1%, p < 0.001). The availability of endovascular treatments increased the chance of having a TC by 2.3-fold (OR = 2.33, 95% CI = 1.30-4.18); however, it did not reduce the chance of having any catheter. A high chance of having a catheter was found when the time to AV access creation exceeded 60 days. The differences between public and private patients may be explained by underpayments and the decreased accessibility to care infrastructure in the public system, especially for endovascular treatments. In this sample, public health patients had a decreased risk of having a TC over an NTC. Differences in care accessibility and insurance type might influence the type of vascular access.

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ABSTRACT Introduction: Aging is a global phenomenon. Recent forecasts indicate that Brazil will be the sixth country in population of elderly individuals in 2020. The incidence of acute kidney injury (AKI) among the elderly varies, but studies have indicated that older individuals are more prone to developing AKI and have higher mortality rates than the general population with renal disease. The impact of dialysis in elderly patients with AKI - and critically ill individuals with multiple dysfunctions - has been discussed for years. Evidence indicates that for this group of patients dialysis does not positively impact survival and, in some situations, it might even accelerate death. This study investigated a population of elderly individuals with AKI seen in intensive care units to assess, through Propensity Score Matching, the impact dialysis has had for them. Methods: Data from the charts of patients aged 60 years or older seen at the intensive care unit of a general hospital between January 2012 and December 2014 and diagnosed with AKI were collected. Results: The study included 329 patients with a mean age of 75.4 ± 9.3 years. Ischemic AKI was the most prevalent disease (54.7%) and 28.9% of the patients needed dialysis. No difference was seen in the death rates of dialysis and non-dialysis patients aged 70+ years. Conclusions: The data suggested that dialysis did not seem to impact the death rates of critically ill patients with AKI aged 70+ years.

RESUMO Introdução: O crescimento da população idosa é um fenômeno mundial. Projeções recentes demonstram que o Brasil será o sexto país do mundo em número de idosos no ano de 2020. A incidência de injúria renal aguda (IRA) nos idosos varia de acordo com a população estudada, mas vários estudos têm sugerido que os idosos são mais suscetíveis ao desenvolvimento de IRA e apresentam maior mortalidade que a população geral. Há anos se discute o real impacto da instituição da diálise em pacientes idosos com IRA, principalmente em pacientes críticos com múltiplas disfunções. Há evidências de que o início da diálise nesses indivíduos não tenha impacto positivo na sobrevida e, em algumas situações, até acelere o óbito. O objetivo deste estudo foi analisar uma população de idosos que desenvolveu IRA em unidades de terapia intensiva e avaliar, através do Propensity Score Matching, o impacto da diálise nesses indivíduos. Métodos: Foram coletados dados de prontuários de idosos acima dos 60 anos, internados na UTI de um hospital geral, de janeiro de 2012 a dezembro de 2014, e que evoluíram com IRA. Resultados: Foram incluídos 329 pacientes, com idade média de 75,4 ± 9,3 anos. A IRA isquêmica foi a mais prevalente (54,7%), e 28,9% necessitaram de diálise. Nos indivíduos acima de 70 anos, não foi observada diferença na mortalidade entre os pacientes que realizaram ou não diálise. Conclusões: Esses dados sugerem que a diálise parece não apresentar impacto sobre a mortalidade de pacientes críticos com IRA, acima de 70 anos.

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INTRODUCTION: Aging is a global phenomenon. Recent forecasts indicate that Brazil will be the sixth country in population of elderly individuals in 2020. The incidence of acute kidney injury (AKI) among the elderly varies, but studies have indicated that older individuals are more prone to developing AKI and have higher mortality rates than the general population with renal disease. The impact of dialysis in elderly patients with AKI - and critically ill individuals with multiple dysfunctions - has been discussed for years. Evidence indicates that for this group of patients dialysis does not positively impact survival and, in some situations, it might even accelerate death. This study investigated a population of elderly individuals with AKI seen in intensive care units to assess, through Propensity Score Matching, the impact dialysis has had for them. METHODS: Data from the charts of patients aged 60 years or older seen at the intensive care unit of a general hospital between January 2012 and December 2014 and diagnosed with AKI were collected. RESULTS: The study included 329 patients with a mean age of 75.4 ± 9.3 years. Ischemic AKI was the most prevalent disease (54.7%) and 28.9% of the patients needed dialysis. No difference was seen in the death rates of dialysis and non-dialysis patients aged 70+ years. CONCLUSIONS: The data suggested that dialysis did not seem to impact the death rates of critically ill patients with AKI aged 70+ years.

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Percutaneous peritoneal catheter insertion can be performed by trained nephrologists. The objective of this study was to compare the outcome of peritoneal dialysis (PD) catheters percutaneous inserted with the traditional surgical technique. One hundred twenty-one PD catheters were placed in 121 stage-5 Chronic kidney disease patients using three techniques: percutaneous insertion (Group P, n = 53), percutaneous insertion guided by radioscopy (Group R, n = 26), and surgical insertion (Group S, n = 42). The mean age of the whole cohort was 57 ± 16 years and 54% were male. Patients and catheter outcomes were followed up prospectively for 19 months. Gender, age, body mass index, previous abdominal surgeries, and the prevalence of diabetes mellitus were not significantly different among the groups as well as the incidence of bleeding and the presence of catheter dysfunction. In addition, the incidence of exit-site infections and peritonitis was not significantly different among the groups. Finally, the survival catheter rate was not significantly different by the end of the follow-up of 19 months (70% in P group, 85% in R, and 70% in S group (log rank = 0.88, p = 0.95). The outcome of percutaneous implanted catheters, which were inserted by a trained nephrologist, did not demonstrate to be inferior as compared with the traditional surgical approach.

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