Abstract Introduction: Exercise is being incorporated into the treatment of patients on hemodialysis; however, little is known about the major characteristics of these interventions. Objective: To describe the exercise protocols prescribed for hemodialysis patients in Brazil. Methods: A scoping review was conducted following JBI and Prisma-ScR guidelines. Searches were carried out in Medline, Embase and three other databases until May 2024. Other sources (websites, books and guidelines) were also investigated. Evidence from patients on hemodialysis describing exercise protocols in all settings and designs in Brazil was included. Results: Forty-five pieces of evidence were found, resulting in 54 exercise protocols from 16 Brazilian states. Strength exercises (33.3%), followed by aerobic exercises (22.2%), were the most prescribed, mainly to be performed during dialysis (85.2%). The most prevalent professionals supervising the programs were physiotherapists and exercise physiologists (37.0% and 18.5%, respectively). All protocols implemented the principles of type and frequency training, while progression was adopted in only 53.7%. The main prescription was three times per week (88.9%). Exercise intensity was predominantly determined by subjective methods (33.3%). Conclusion: Aerobic and strength exercises during dialysis were the most commonly prescribed modalities in Brazil, with the majority of programs being properly supervised by qualified professionals. However, existing protocols have not employed systematic progression throughout the intervention, which would be appropriate for providing better physiological responses and adaptations. Introduction however interventions Objective Methods PrismaScR Prisma ScR guidelines Medline 2024 websites, websites (websites investigated included Results Fortyfive Forty five found 5 1 states 33.3%, 333 33.3% , 33 3 (33.3%) 22.2%, 222 22.2% 22 2 (22.2%) 85.2%. 852 85.2% . 85 (85.2%) 37.0% 370 37 0 (37.0 185 18 18.5% respectively. respectively respectively) training 537 53 7 53.7% 88.9%. 889 88.9% 88 9 (88.9%) 33.3%. Conclusion However intervention adaptations 202 33.3 (33.3% 22.2 (22.2% 85.2 8 (85.2% 37.0 (37. 18.5 53.7 88.9 (88.9% 20 33. (33.3 22. (22.2 85. (85.2 37. (37 18. 53. 88. (88.9 (33. (22. (85. (3 (88. (33 (22 (85 ( (88 (2 (8

Resumo Introdução: O exercício físico está sendo incorporado ao tratamento de pacientes em hemodiálise, porém pouco se sabe sobre as principais características dessas intervenções. Objetivo: Descrever os protocolos de exercício físico prescritos para pacientes em hemodiálise no Brasil. Métodos: Uma revisão de escopo foi conduzida de acordo com as diretrizes JBI e Prisma-ScR. Foram realizadas pesquisas na Medline, Embase e em outras três bases de dados até maio de 2024. Outras fontes (sites, livros e diretrizes) também foram pesquisadas. Foram incluídas evidências de pacientes em hemodiálise, descrevendo protocolos de exercício físico em todos os ambientes e desenhos no Brasil. Resultados: Encontradas 45 evidências, resultando em 54 protocolos de exercício físico de 16 estados brasileiros. O exercício de força (33,3%), seguido do exercício aeróbico (22,2%), foi o mais prescrito para ser realizado durante a diálise (85,2%). Os profissionais mais prevalentes na supervisão dos programas foram fisioterapeutas e profissionais de educação física (37,0% e 18,5%, respectivamente). Todos os protocolos adotaram os princípios de treinamento tipo e frequência, enquanto a progressão foi adotada em apenas 53,7%. A frequência mais prescrita foi três vezes por semana (88,9%). A intensidade do exercício foi determinada predominantemente por métodos subjetivos (33,3%). Conclusão: Os exercícios aeróbicos e de força durante a diálise foram as modalidades mais prescritas no Brasil, com a maioria dos programas sendo adequadamente supervisionada por profissionais qualificados. No entanto, os protocolos existentes não adotaram a progressão sistemática no decorrer da intervenção, o que seria adequado para proporcionar melhores respostas e adaptações fisiológicas. Introdução intervenções Objetivo Brasil Métodos PrismaScR. PrismaScR Prisma ScR. ScR Prisma-ScR Medline 2024 sites, sites (sites pesquisadas Resultados 4 5 1 brasileiros 33,3%, 333 33,3% , 33 3 (33,3%) 22,2%, 222 22,2% 22 2 (22,2%) 85,2%. 852 85,2% . 85 (85,2%) 37,0% 370 37 0 (37,0 185 18 18,5% respectivamente. respectivamente respectivamente) 537 53 7 53,7% 88,9%. 889 88,9% 88 9 (88,9%) 33,3%. Conclusão qualificados entanto intervenção fisiológicas 202 33,3 (33,3% 22,2 (22,2% 85,2 8 (85,2% 37,0 (37, 18,5 53,7 88,9 (88,9% 20 33, (33,3 22, (22,2 85, (85,2 37, (37 18, 53, 88, (88,9 (33, (22, (85, (3 (88, (33 (22 (85 ( (88 (2 (8

Abstract Introduction: The malnutrition-inflammation process is one of the main causes of morbidity and mortality in patients with chronic kidney disease (CKD), influencing quality of life. The aim of this study was to identify the inflammatory and nutritional status of elderly hemodialysis (HD) and its association with quality of life. Methods: This study was carried out in health services in three different cities. The Malnutrition-Inflammation Score (MIS) was used to assess the inflammatory and nutritional status, with anthropometric measurements, protein status, lean mass and function. The quality of life was assessed using KDQOL-SFTM. Data were analyzed using multivariate analysis and the Poisson model to evaluate the factors that increased the risk of developing malnutrition and inflammation. Results: The MIS identified a 52.2% prevalence of malnutrition and inflammation in the population. In univariate analysis, most KDQOL-SFTM domains presented higher scores for nourished elderly. Anthropometric measures associated with muscle mass and functionality were lower in the malnourished elderly. Multivariate modeling revealed a higher nutritional risk of 50.6% for women and older age, since with each additional year of life the risk of malnutrition increased by 2.4% and by 0.4% with each additional month on HD. Greater arm muscle circumference (AMC) and higher serum albumin were factors for reducing malnutrition by 4.6% and 34.7%, respectively. Conclusion: Higher serum albumin and preserved AMC have been shown to be good indicators of better nutritional status. Higher MIS was associated with poorer quality of life, older age, lower income and education, longer time on dialysis, and presence of comorbidities. Introduction malnutritioninflammation CKD, CKD , (CKD) HD (HD Methods cities MalnutritionInflammation Malnutrition Inflammation (MIS measurements function KDQOLSFTM. KDQOLSFTM KDQOL SFTM. SFTM Results 522 52 2 52.2 population 506 50 6 50.6 age 24 4 2.4 04 0 0.4 (AMC 46 4.6 347 34 7 34.7% respectively Conclusion education dialysis comorbidities (CKD 5 52. 50. 2. 0. 4. 3 34.7 34.

Resumo Introdução: O processo de desnutrição-inflamação é uma das principais causas de morbimortalidade em pacientes com DRC, influenciando a qualidade de vida. O objetivo deste estudo foi identificar o estado inflamatório e nutricional de idosos em hemodiálise (HD) e sua associação com qualidade de vida. Métodos: Estudo realizado em serviços de saúde de três cidades diferentes. O Escore de Desnutrição-Inflamação (MIS, por sua sigla em inglês) foi utilizado para avaliar estado inflamatório e nutricional, com medidas antropométricas, estado proteico, massa magra e funcionalidade. A qualidade de vida foi avaliada com KDQOL-SFTM. Os dados foram analisados utilizando análise multivariada e modelo de Poisson para avaliar fatores que aumentaram o risco de desenvolver desnutrição e inflamação. Resultados: O MIS identificou prevalência de 52,2% de desnutrição e inflamação na população. Na análise univariada, a maioria dos domínios do KDQOL-SFTM apresentou escores maiores para idosos nutridos. Medidas antropométricas associadas à massa muscular e funcionalidade foram menores em idosos desnutridos. A modelagem multivariada revelou maior risco nutricional de 50,6% para mulheres e idosos pois o risco de desnutrição aumentou em 2,4% para cada ano adicional de vida e em 0,4% para cada mês adicional de HD. Maior circunferência muscular do braço (CMB) e maior albumina sérica foram fatores de redução da desnutrição em 4,6% e 34,7%, respectivamente. Conclusão: Demonstrou-se que albumina sérica mais elevada e CMB preservada são bons indicadores de melhor estado nutricional. Maior MIS foi associado a pior qualidade de vida, idade mais avançada, menor renda e escolaridade, maior tempo em diálise e presença de comorbidades. Introdução desnutriçãoinflamação DRC HD (HD Métodos diferentes DesnutriçãoInflamação Desnutrição Inflamação MIS, (MIS inglês proteico KDQOLSFTM. KDQOLSFTM KDQOL SFTM. SFTM Resultados 522 52 2 52,2 população univariada nutridos desnutridos 506 50 6 50,6 24 4 2,4 04 0 0,4 (CMB 46 4,6 347 34 7 34,7% respectivamente Conclusão Demonstrouse Demonstrou se avançada escolaridade comorbidades 5 52, 50, 2, 0, 4, 3 34,7 34,

Resumo Introdução: Disfunção erétil (DE) é um problema sexual comum entre homens com doença renal crônica (DRC). A gravidade da disfunção sexual tende a piorar com a lesão renal. Este estudo tem como objetivo avaliar função erétil e qualidade de vida sexual de pacientes homens adultos com DRC em hemodiálise (HD) em um hospital na Amazônia brasileira. Métodos: Realizou-se estudo quantitativo transversal no Setor de HD da Unidade de Nefrologia, incluindo homens com DRC ≥ 18 anos, submetidos a ≥ 3 sessões semanais de HD por ≥ 3 meses e sexualmente ativos por ≥ 6 meses. Utilizamos o Quociente Sexual Masculino (QSM) para medir satisfação sexual e o Índice Internacional de Função Erétil (IIEF5) para estabelecer função erétil. A análise estatística foi realizada com o SPSS 21.0 usando testes apropriados, como Mann-Whitney e Kruskal-Wallis (P < 0,05). Resultados: Avaliamos 98 pacientes (51,68 ± 15,28 anos). Eles eram predominantemente casados/ou vivendo com um(a) parceiro(a) (60,20%), com tempo de HD entre 1 e 5 anos (55,10%) e KTV médio de 1,17. A prevalência de DE foi 66,30% e foi associada a maior faixa etária (p = 0,01), menor renda familiar (p = 0,02), diabetes (p = 0,01), menor hemoglobina corpuscular média (p = 0,04), maior cálcio total (p = 0,04) e menor albumina (p = 0,03). Aproximadamente 75% classificaram sua vida sexual como regular a excelente. Conclusão: Apesar da elevada prevalência de DE, a maioria dos homens com DRC em HD relatou vida sexual regular a excelente. O estudo ressalta a importância de estabelecer triagem eficaz e realizar avaliações de rotina sobre questões sexuais nesses homens. Introdução (DE DRC. . (DRC) (HD brasileira Métodos Realizouse Realizou se Nefrologia QSM (QSM IIEF5 IIEF (IIEF5 210 21 0 21. apropriados MannWhitney Mann Whitney KruskalWallis Kruskal Wallis P 0,05. 005 0,05 05 0,05) Resultados 9 51,68 5168 51 68 (51,6 1528 15 28 15,2 anos. anos) casadosou casados ou uma um(a parceiroa parceiro parceiro(a 60,20%, 6020 60,20% , 60 20 (60,20%) 55,10% 5510 55 10 (55,10% 117 17 1,17 6630 66 30 66,30 p 0,01, 001 0,01 01 0,01) 0,02, 002 0,02 02 0,02) 0,04, 004 0,04 04 0,03. 003 0,03 03 0,03) 75 excelente Conclusão (DRC (IIEF 2 00 0,0 51,6 516 (51, 152 15, 602 60,20 (60,20% 55,10 551 (55,10 11 1,1 663 66,3 7 0, 51, (51 60,2 (60,20 55,1 (55,1 1, 66, (5 60, (60,2 55, (55, ( (60, (55 (60 (6

Abstract Introduction: Erectile dysfunction (ED) is a common sexual problem among men with chronic kidney disease (CKD). The severity of sexual dysfunction tends to worsen with kidney damage. This study aims to evaluate the erectile function and sexual quality of life of adult male CKD patients undergoing hemodialysis (HD) in a hospital located in the Brazilian Amazon. Methods: A cross-sectional quantitative study was performed within the HD Sector of the Nephrology Unit including men with CKD aged ≥ 18 years, undergoing ≥ 3 weekly HD sessions for ≥ 3 months who had been sexually active for ≥ 6 months. We used the Male Sexual Quotient (MSQ) to measure sexual satisfaction and the International Index of Erectile Function (IIEF5) to establish erectile function. Statistical analysis was performed with SPSS 21.0 using appropriate tests, such as Mann-Whitney and Kruskal-Wallis (P < 0.05). Results: Ninety-eight patients (51.68 ± 15.28 years) were evaluated. They were primarily married/or living with a partner (60.20%), with HD time between 1 to 5 years (55.10%), and an average KTV of 1.17. ED prevalence was 66.30%, and it was associated with a higher age group (p = 0.01), lower family income (p = 0.02), diabetes (p = 0.01), lower mean corpuscular hemoglobin (p = 0.04), higher total calcium (p = 0.04), and lower albumin (p = 0.03). Around 75% classified their sex life as regular to excellent. Conclusion: Despite the high ED prevalence, most men with CKD in HD reported experiencing regular to excellent sex life. The study underscores the importance of establishing effective screening and conducting routine evaluations regarding sexual issues in these men. Introduction (ED CKD. . (CKD) damage (HD Amazon Methods crosssectional cross sectional MSQ (MSQ IIEF5 IIEF (IIEF5 210 21 0 21. tests MannWhitney Mann Whitney KruskalWallis Kruskal Wallis P 0.05. 005 0.05 05 0.05) Results Ninetyeight Ninety eight 51.68 5168 51 68 (51.6 1528 15 28 15.2 evaluated marriedor married or 60.20%, 6020 60.20% , 60 20 (60.20%) 55.10%, 5510 55.10% 55 10 (55.10%) 117 17 1.17 6630 66 30 66.30% p 0.01, 001 0.01 01 0.01) 0.02, 002 0.02 02 0.02) 0.04, 004 0.04 04 0.04) 0.03. 003 0.03 03 0.03) 75 Conclusion (CKD (IIEF 2 00 0.0 51.6 516 (51. 152 15. 602 60.20 (60.20% 551 55.10 (55.10% 11 1.1 663 66.30 7 0. 51. (51 60.2 (60.20 55.1 (55.10 1. 66.3 (5 60. (60.2 55. (55.1 66. ( (60. (55. (60 (55 (6

SUMMARY OBJECTIVE: This study was conducted to determine the effect of relaxation exercise on fatigue symptoms in hemodialysis patients. METHODS: This is a meta-analysis study. The literature review was carried out by searching studies published between 2011 and 2020. This meta-analysis was recorded on PROSPERO in the National Health Research Institute (Registration no: CRD42022313646). RESULTS: Seven studies meeting the inclusion criteria were included in the meta-analysis. The effect size of the studies included in the meta-analysis was found to be g=1.232 (p=0.028), which indicated a "huge effect size." The scale used in the subgroup analyses, the application time of the relaxation exercise, and the number of relaxation exercise applications were evaluated, and a significant difference was found at p<0.05. CONCLUSION: Relaxation exercises can be used as an effective method for reducing fatigue in hemodialysis patients. OBJECTIVE patients METHODS metaanalysis meta analysis 201 2020 Registration no CRD42022313646. CRD42022313646 CRD . CRD42022313646) RESULTS metaanalysis. analysis. g1232 g 1 232 g=1.23 p=0.028, p0028 p p=0.028 , 0 028 (p=0.028) huge size. analyses evaluated p005 05 p<0.05 CONCLUSION 20 202 CRD4202231364 g123 23 g=1.2 p002 p=0.02 02 (p=0.028 p00 p<0.0 2 CRD420223136 g12 g=1. p=0.0 (p=0.02 p0 p<0. CRD42022313 g1 g=1 p=0. (p=0.0 p<0 CRD4202231 g= p=0 (p=0. p< CRD420223 p= (p=0 CRD42022 (p= CRD4202 (p CRD420 CRD42 CRD4

Introduction: Patients with end-stage renal disease (ESRD) frequently change renal replacement (RRT) therapy modality due to medical or social reasons. We aimed to evaluate the outcomes of patients under peritoneal dialysis (PD) according to the preceding RRT modality. Methods: We conducted a retrospective observational single-center study in prevalent PD patients from January 1, 2010, to December 31, 2017, who were followed for 60 months or until they dropped out of PD. Patients were divided into three groups according to the preceding RRT: prior hemodialysis (HD), failed kidney transplant (KT), and PD-first. Results: Among 152 patients, 115 were PD-first, 22 transitioned from HD, and 15 from a failing KT. There was a tendency for ultrafiltration failure to occur more in patients transitioning from HD (27.3% vs. 9.6% vs. 6.7%, p = 0.07). Residual renal function was better preserved in the group with no prior RRT (p < 0.001). A tendency towards a higher annual rate of peritonitis was observed in the prior KT group (0.70 peritonitis/year per patient vs. 0.10 vs. 0.21, p = 0.065). Thirteen patients (8.6%) had a major cardiovascular event, 5 of those had been transferred from a failing KT (p = 0.004). There were no differences between PD-first, prior KT, and prior HD in terms of death and technique survival (p = 0.195 and p = 0.917, respectively) and PD efficacy was adequate in all groups. Conclusions: PD is a suitable option for ESRD patients regardless of the previous RRT and should be offered to patients according to their clinical and social status and preferences. Introduction endstage end stage (ESRD (RRT reasons (PD Methods singlecenter single center 1 2010 31 2017 6 , (HD) (KT) PDfirst. PDfirst first. first PD-first Results 11 PDfirst, first, 2 27.3% 273 27 3 (27.3 vs 96 9 9.6 67 7 6.7% 0.07. 007 0.07 . 0 07 0.07) 0.001. 0001 0.001 001 0.001) 0.70 070 70 (0.7 peritonitisyear year 010 10 0.1 021 21 0.21 0.065. 0065 0.065 065 0.065) 8.6% 86 8 (8.6% event 0.004. 0004 0.004 004 0.004) 0195 195 0.19 0917 917 0.917 respectively Conclusions preferences 201 (HD (KT 27.3 (27. 9. 6.7 00 0.0 000 0.00 0.7 (0. 01 0. 02 0.2 006 0.06 06 8.6 (8.6 019 19 091 91 0.91 20 27. (27 6. (0 8. (8. 09 0.9 (2 ( (8

Introdução: Pacientes com doença renal em estágio terminal (DRET) frequentemente mudam de modalidade de terapia renal substitutiva (TRS) por razões médicas ou sociais. Nosso objetivo foi avaliar desfechos de pacientes em diálise peritoneal (DP) segundo a modalidade anterior de TRS. Métodos: Realizamos estudo retrospectivo observacional unicêntrico, em pacientes prevalentes em DP, de 1º de janeiro de 2010 a 31 de dezembro de 2017, acompanhados por 60 meses ou até saírem de DP. Pacientes foram divididos em três grupos de acordo com a TRS anterior: hemodiálise prévia (HD), transplante renal malsucedido (TR) e DP como primeira opção (PD-first). Resultados: Entre 152 pacientes, 115 eram PD-first, 22 transitaram da HD e 15 de TR malsucedido. Houve tendência à maior ocorrência de falência de ultrafiltração em pacientes em transição da HD (27,3% vs. 9,6% vs. 6,7%; p = 0,07). A função renal residual foi melhor preservada no grupo sem TRS prévia (p < 0,001). Observou-se tendência à maior taxa anual de peritonite no grupo TR prévio (0,70 peritonite/ano por paciente vs. 0,10 vs. 0,21; p = 0,065). Treze pacientes (8,6%) tiveram um evento cardiovascular maior, cinco dos quais haviam sido transferidos de um TR malsucedido (p = 0,004). Não houve diferenças entre PD-first, TR prévio e HD prévia em termos de óbito e sobrevida da técnica (p = 0,195 e p = 0,917, respectivamente) e a eficácia da DP foi adequada em todos os grupos. Conclusões: A DP é uma opção adequada para pacientes com DRET, independentemente da TRS anterior, e deve ser oferecida aos pacientes de acordo com seu status clínico e social e suas preferências. Introdução DRET (DRET (TRS sociais (DP Métodos unicêntrico º 201 3 2017 6 HD, , (HD) (TR PDfirst. PDfirst PD first . (PD-first) Resultados 11 PDfirst, first, PD-first 2 1 27,3% 273 27 (27,3 vs 96 9 9,6 6,7% 67 7 0,07. 007 0,07 0 07 0,07) 0,001. 0001 0,001 001 0,001) Observouse Observou se 0,70 070 70 (0,7 peritoniteano ano 010 10 0,1 0,21 021 21 0,065. 0065 0,065 065 0,065) 8,6% 86 8 (8,6% 0,004. 0004 0,004 004 0,004) 0195 195 0,19 0917 917 0,917 respectivamente Conclusões preferências 20 (HD (PD-first 27,3 (27, 9, 6,7 00 0,0 000 0,00 0,7 (0, 01 0, 0,2 02 006 0,06 06 8,6 (8,6 019 19 091 91 0,91 27, (27 6, (0 8, (8, 09 0,9 (2 ( (8

Resumo Introdução: O hiperparatireoidismo secundário (HPTS) é uma das causas de inflamação na DRC. Avaliamos o impacto da paratireoidectomia (PTX) nas relações neutrófilo/linfócito (N/L) e plaqueta/linfócito (P/L) em pacientes com HPTS. Métodos: Foram analisados 118 pacientes [hemodiálise (HD, n = 81) e transplantados (TX, n = 37)] submetidos à PTX entre 2015 e 2021. Resultados: Houve redução significativa de cálcio e PTH nos dois grupos, além de elevação de vitamina D. No grupo HD, a PTX não mudou as relações N/L e P/L. Já no grupo TX, houve redução nas relações N/L e P/L acompanhadas de elevação significativa do número de linfócitos totais. Conclusão: As relações N/L e P/L não são marcadores fidedignos de inflamação em pacientes com HPTS submetidos à PTX. A uremia, que induz um estado de inflamação crônica em pacientes dialíticos, e o uso de imunossupressão em pacientes transplantados renais são alguns dos fatores de confusão que impedem o uso dessa ferramenta na prática clínica. Introdução (HPTS DRC (PTX neutrófilolinfócito neutrófilo linfócito NL N L (N/L plaquetalinfócito plaqueta PL P (P/L Métodos 11 hemodiálise HD (HD 81 TX (TX 37 37) 201 2021 Resultados grupos D totais Conclusão uremia dialíticos clínica 1 8 3 20 202 2

Abstract Introduction: Secondary hyperparathyroidism (SHPT) is one of the causes for inflammation in CKD. We assessed the impact of parathyroidectomy (PTX) on neutrophil-to-lymphocyte (N/L) and platelet-to-lymphocyte (P/L) ratios in SHPT patients. Methods: A total of 118 patients [hemodialysis (HD, n = 81), and transplant recipients (TX, n = 37)] undergoing PTX between 2015 and 2021 were analyzed. Results: There was a significant reduction in calcium and PTH levels in both groups, in addition to an increase in vitamin D. In the HD group, PTX did not alter N/L and P/L ratios. In the TX group, there was a reduction in N/L and P/L ratios followed by a significant increase in total lymphocyte count. Conclusion: N/L and P/L ratios are not reliable biomarkers of inflammation in SHPT patients undergoing PTX. Uremia, which induces a state of chronic inflammation in dialysis patients, and the use of immunosuppression in kidney transplant recipients are some of the confounding factors that prevent the use of this tool in clinical practice. Introduction (SHPT CKD (PTX neutrophiltolymphocyte neutrophil NL N L (N/L platelettolymphocyte platelet PL P (P/L Methods 11 hemodialysis HD, (HD 81, 81 , 81) TX, (TX 37 37) 201 202 analyzed Results groups D group count Conclusion Uremia practice 1 8 3 20 2

RESUMEN Introducción: los pacientes con enfermedad renal crónica con requerimiento de terapia sustitutiva renal (hemodiálisis) son frecuentes en el Paraguay, lo que afecta la calidad de vida de los que la padecen. Objetivo: conocer la calidad de vida de los pacientes con enfermedad renal crónica en tratamiento hemodialítico en el Departamento de Nefrología del Centro Médico Nacional-Hospital Nacional en el período 2022-2023. Metodología: observacional, descriptivo, de corte transversal realizado en el Departamento de Nefrología del Centro Médico Nacional-Hospital Nacional de Paraguay. Se incluyeron en el estudio 189 pacientes en que acudieron para tratamiento hemodialítico entre los años 2022-2023. La muestra fue censal. Para determinar la calidad de vida se utilizó el cuestionario Kidney Disease Quality of Life - 36 ítems. Los datos fueron analizados con el programa Epiinfo. Resultados: la edad media de los pacientes fue de 53 años, varones 58.2 %. El 98 % refirió la presencia de algún tipo de comorbilidad concomitante, las más frecuentes fueron diabetes Mellitus 43 % e hipertensión arterial 86 %. La media de meses en tratamiento hemodialítico fue de 20 meses. El cuestionario, Kidney Disease Quality of Life - 36 ítems, arrojó puntajes promedios menores a 50 en el componente mental (65.08) y en el componente físico (71.95) así como en la subescala carga de la enfermedad (55.55). Conclusión: la mayoría de los pacientes con enfermedad renal crónica con tratamiento hemodialítico en el Hospital Nacional evidencian una baja calidad de vida.

ABSTRACT Introduction: patients with chronic kidney disease requiring renal replacement therapy (hemodialysis) are common in Paraguay, which affects the quality of life of those who suffer from it. Objective: to know the quality of life of patients with chronic kidney disease undergoing hemodialysis treatment in the Departmento de Nefrología of the Centro Médico Nacional-Hospital Nacional in the period 2022-2023. Methodology: observational, descriptive, cross-sectional carried out in the Nephrology Department of the Centro Médico Nacional-Hospital Nacional of Paraguay. 189 patients who came for hemodialysis treatment between 2022-2023 were included in the study. The sample was census. To determine quality of life, the Kidney Disease Quality of Life questionnaire - 36 items was used. The data were analyzed with the Epi Info program. Results: the average age of the patients was 53 years, 58.2 % men. 98 % reported the presence of some type of concomitant comorbidity, the most frequent being diabetes mellitus 43 % and arterial hypertension 86 %. The average number of months on hemodialysis treatment was 20 months. The questionnaire, Kidney Disease Quality of Life - 36 items, showed average scores less than 50 in the mental component (65.08) and in the physical component (71.95) as well as in the burden of the disease subscale (55.55). Conclusion: the majority of patients with chronic kidney disease with hemodialysis treatment at the National Hospital show a low quality of life.

ABSTRACT Introduction: Chronic Kidney Disease has gained interest due to its high morbidity and mortality rate. In addition to vascular causes and diabetes mellitus, an unknown cause has been identified in young farmers. Objective: This study aims to determine the prevalence of the population on hemodialysis, suspected of Chronic Interstitial Nephritis in agricultural communities, to categorize the true etiology of their renal pathology. Methodology: A descriptive observational design was applied during December 2022, January, and February 2023; and 684 patients of both sexes were surveyed in 8 hemodialysis centers in the Capital and the Central Department of Paraguay. Results: The prevalence of suspected cases due to the exposure to risk factors was 18.1%. This figure could be higher since 22.6% of patients with type 2 diabetes mellitus did not present clinical retinopathy or other clinical signs of the disease at the time of the diagnosis of kidney failure. This scenario warns us of a probable misdiagnosis in a considerable number of patients. Conclusion: The importance of this research lies in generating preventive actions in the agricultural population and raising awareness in the medical community about the diagnostic relevance of this pathology to improve the quality and prognosis of life in the Paraguayan population.

RESUMEN Introducción: La Enfermedad Renal Crónica ha cobrado interés debido a su alta tasa de morbimortalidad. Además de las causas vasculares y de la diabetes mellitus, se ha identificado una causa de Origen Desconocido en jóvenes agricultores. Objetivo: El objetivo del estudio es determinar la prevalencia de la población en hemodiálisis, sospechosa de la Nefritis Intersticial Crónica en Comunidades Agrícolas, para categorizar la verdadera etiología de su patología renal. Metodología: Se aplicó un diseño observacional descriptivo durante los meses de diciembre de 2022, enero y febrero de 2023; y se encuestó a 684 pacientes de ambos sexos en 8 centros de hemodiálisis de la Capital y el Departamento Central del Paraguay. Resultados: La prevalencia de casos sospechosos por la exposición a factores de riesgo resultó ser del 18.1%. Esta cifra podría ser mayor, ya que 22.6% de los pacientes con diabetes mellitus tipo 2, no presentó retinopatía clínica ni otros signos clínicos de la enfermedad al momento del diagnóstico de la falla renal. Este panorama nos advierte de un probable diagnóstico desacertado en una cantidad considerable de pacientes. Conclusión: La importancia de esta investigación se sustenta en generar acciones preventivas en la población agrícola y concientizar a la sociedad médica de la relevancia diagnóstica de esta patología para mejorar la calidad y pronóstico de vida en la población paraguaya.

ABSTRACT Introduction: Chronic kidney disease is a global health problem. Its most serious manifestation, chronic kidney failure, affects the Cuban context and determines the growth of patients on hemodialysis. The objective of the text is to evaluate the main results of the diagnosis and characterization of the problematic situation in a psychosocial study with patients with Chronic Renal Failure in the Hemodialysis room of the Florida municipality, of the county of Camagüey. Method: It is an experimental participatory action research, which takes place between January 2023 and December 2024, which constitutes the output of the research project System of psychosocial actions for the improvement of comprehensive care for patients with non-communicable diseases. The universe is made up of 56 patients and the sample is made up of 22, who receive purifying and conservative treatment, 22 family members and 12 service professionals. The research instrument par excellence was the participant survey. Results: The age of the patients is not definitive of an age group; men predominate; A high percentage of patients are found to have low tolerance for adherence to treatment and insufficient development of psychosocial skills and declare the need to possess knowledge to achieve health states that lead to survival. Discussion: There is no coincidence with what was found in the determination of the prevalence age groups for the disease, but specialists insist that the disease is not exclusive to a specific period of life; recognize the importance of the patient's knowledge of risk factors for prevention, promotion and health education and highlight the need for communication and empathy between health personnel and the patient, to achieve favorable results and emotional states in the face of the disease and treatment.

RESUMEN Introducción: La enfermedad renal crónica es un problema de salud a nivel mundial, su manifestación más grave, la insuficiencia renal crónica, incide en el contexto cubano y determina el crecimiento de pacientes en hemodiálisis. El objetivo del texto es valorar los principales resultados del diagnóstico y caracterización de la situación problémica en un estudio de carácter psicosocial con pacientes con Insuficiencia Renal Crónica en la sala de Hemodiálisis del municipio Florida, de la provincia de Camagüey. Método: Es una investigación-acción participativa de corte experimental, que se desarrolla entre enero 2023 y diciembre del 2024 la cual constituye salida del proyecto de investigación Sistema de acciones psicosociales para el perfeccionamiento de la atención integral a los pacientes con enfermedades no transmisibles. El universo está constituido por 56 pacientes y la muestra por 22, que reciben tratamiento depurador y conservador, 22 familiares y 12 profesionales del servicio. El instrumento de investigación por excelencia fue la encuesta a participantes. Resultados: La edad de los pacientes no es definitiva de un grupo etario; predominan los hombres; se constata un elevado por ciento de pacientes con poca tolerancia a la adherencia al tratamiento e insuficiente desarrollo de las habilidades psicosociales y declaran la necesidad de poseer conocimientos para lograr estados de salud que conlleven a la sobrevida. Discusión: No existe coincidencia con lo constatado en la determinación de los grupos etarios de prevalencia para la enfermedad, pero los especialistas insisten en que la enfermedad no es privativa de un período de vida específico; reconocen la importancia del conocimiento de los factores de riesgo por el paciente para la prevención, promoción y educación en salud y resaltan la necesidad de la comunicación y la empatía entre el personal de salud y el paciente, para lograr resultados y estados emocionales favorables ante la enfermedad y el tratamiento.

ABSTRACT The CONVINCE study, recently published in the New England Journal of Medicine, reveals a groundbreaking 23% reduction in the relative risk of all-cause mortality among end-stage kidney patients undergoing high convective volume hemodiafiltration. This significant finding challenges the conventional use of high-flux hemodialysis and offers hope for improving outcomes in chronic kidney disease patients. While some controversies surround the study’s findings, including concerns about generalizability and the causes of death, it is essential to acknowledge the study’s design and its main outcomes. The CONVINCE study, part of the HORIZON 2020 project, enrolled 1360 patients and demonstrated the superiority of hemodiafiltration in reducing all-cause mortality overall, as well as in specific patient subgroups (elderly, short vintage, non-diabetic, and those without cardiac issues). Interestingly, it was shown that hemodiafiltration had a protective effect against infection, including COVID-19. Future research will address sustainability, dose scaling effects, identification of subgroups especially likely to benefit and cost-effectiveness. However, for now, the findings strongly support a broader adoption of hemodiafiltration in renal replacement therapy, marking a significant advancement in the field. study Medicine 23 allcause all cause endstage end stage highflux flux studys s death 202 project 136 overall elderly, elderly (elderly vintage nondiabetic, nondiabetic non diabetic, diabetic non-diabetic issues. issues . issues) Interestingly infection COVID19. COVID19 COVID 19. 19 COVID-19 sustainability effects costeffectiveness. costeffectiveness cost effectiveness. effectiveness cost-effectiveness However now therapy field 2 20 13 COVID1 1 COVID-1 COVID-

RESUMO O estudo CONVINCE, publicado recentemente no New England Journal of Medicine, revela uma redução inovadora de 23% no risco relativo de mortalidade por todas as causas entre pacientes renais em estágio terminal submetidos à hemodiafiltração de alto volume de convecção. Esse achado significativo desafia o uso convencional da hemodiálise de alto fluxo e oferece esperança de melhoria dos desfechos em pacientes com doença renal crônica. Embora algumas controvérsias cerquem os achados do estudo, incluindo preocupações sobre a generalização e as causas de óbito, é essencial reconhecer o desenho do estudo e seus principais desfechos. O estudo CONVINCE, parte do projeto HORIZON 2020, inscreveu 1.360 pacientes e demonstrou a superioridade da hemodiafiltração na redução da mortalidade por todas as causas em geral, bem como em subgrupos específicos de pacientes (idosos, HD de curta duração, não diabéticos e aqueles sem problemas cardíacos). Curiosamente, demonstrou-se que a hemodiafiltração teve um efeito protetor contra infecções, incluindo a COVID-19. Pesquisas futuras abordarão sustentabilidade, efeitos de escalonamento da dose, identificação de subgrupos especialmente propensos a se beneficiar e a relação custo-benefício. No entanto, por ora, os achados apoiam fortemente uma adoção mais ampla da hemodiafiltração na terapia renal substitutiva, marcando um avanço significativo na área. CONVINCE Medicine 23 convecção crônica óbito 2020 1360 1 360 1.36 geral idosos, idosos (idosos duração cardíacos. cardíacos . cardíacos) Curiosamente demonstrouse infecções COVID19. COVID19 COVID 19. 19 COVID-19 sustentabilidade dose custobenefício. custobenefício custo benefício. benefício custo-benefício entanto ora substitutiva área 2 202 136 36 1.3 COVID1 COVID-1 20 13 3 1. COVID-

Abstract Introduction: The Brazilian Dialysis Survey (BDS) is an annual national survey about patients on chronic dialysis that contributes to health policies. Objective: To report the 2022 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). Methods: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire that included clinical and epidemiological aspects of patients on chronic dialysis, dialysis therapy data, and dialysis center characteristics. Results: Overall, 28% (n = 243) of the centers answered the questionnaire. In July 2022, the estimated total number of patients on dialysis was 153,831. The estimated prevalence and incidence rates of patients per million population (pmp) were 758 and 214, respectively. Of the prevalent patients, 95.3% were on hemodialysis (HD, 4.6% of these on hemodiafiltration) and 4.7% on peritoneal dialysis (PD). Only 1.3% of patients were not vaccinated against COVID-19. The prevalence of anemia (Hb < 10g/dL) was 27% and hyperphosphatemia (P > 5.5mg/dL) reached 30%. The estimated overall crude annual mortality rate was 17.1%. Conclusions: The absolute number and prevalence rate of patients on chronic dialysis continue to increase. A growing number of patients were receiving hemodiafiltration. The mortality rate decreased, probably due to the end of COVID-19 pandemic. The conclusions were drawn in the context of relatively low voluntary participation, which imposed methodological limitations on our estimates. Introduction (BDS policies Objective 202 BSN. BSN . (BSN) Methods characteristics Results Overall 28 n 243 153831 153 831 153,831 pmp (pmp 75 214 respectively 953 95 3 95.3 HD, HD (HD 46 4 6 4.6 hemodiafiltration 47 7 4.7 PD. PD (PD) 13 1 1.3 COVID19. COVID19 COVID 19. 19 Hb 10g/dL 10gdL gdL 10g dL g 27 P 5.5mg/dL 55mgdL mgdL 5 5mg mg 30 30% 171 17 17.1% Conclusions increase decreased COVID-1 pandemic participation estimates 20 (BSN 2 24 15383 15 83 153,83 21 9 95. 4. (PD 1. COVID1 17.1 COVID- 1538 8 153,8 17. 153,

Resumo Introdução: O Censo Brasileiro de Diálise (CBD) é uma pesquisa nacional anual sobre pacientes em diálise crônica que contribui para as políticas de saúde. Objetivo: Informar os dados epidemiológicos de 2022 do CBD da Sociedade Brasileira de Nefrologia (SBN). Métodos: Foi realizada uma pesquisa em centros brasileiros de diálise por meio de um questionário online que incluiu aspectos clínicos e epidemiológicos de pacientes em diálise crônica, dados da terapia dialítica e características do centro de diálise. Resultados: No total, 28% (n = 243) dos centros de diálise ativos cadastrados na SBN responderam ao questionário. Em julho de 2022, o número total estimado de pacientes em diálise era de 153.831. As taxas estimadas de prevalência e incidência de pacientes por milhão (ppm) de habitantes foram 758 e 214, respectivamente. Dos pacientes prevalentes, 95,3% estavam em hemodiálise (HD; 4,6% desses em hemodiafiltração) e 4,7% em diálise peritoneal (DP). Apenas 1,3% dos pacientes não foram vacinados contra a COVID-19. A prevalência de anemia (Hb < 10g/dL) foi de 27% e de hiperfosfatemia (P > 5,5mg/dL) alcançou 30%. A taxa bruta total anual de mortalidade estimada foi de 17,1%. Conclusões: O número absoluto e a taxa de prevalência de pacientes em diálise crônica continuam a aumentar. Um número crescente de pacientes estava em hemodiafiltração. A taxa de mortalidade diminuiu, provavelmente devido ao fim da pandemia da COVID-19. As conclusões foram de um contexto de participação voluntária relativamente baixa, o que impõe limitações metodológicas às nossas estimativas. Introdução (CBD saúde Objetivo 202 SBN. . (SBN) Métodos Resultados 28 n 243 153831 153 831 153.831 ppm (ppm 75 214 respectivamente prevalentes 953 95 3 95,3 HD (HD 46 4 6 4,6 hemodiafiltração 47 7 4,7 DP. DP (DP) 13 1 1,3 COVID19. COVID19 COVID 19. 19 COVID-19 Hb 10g/dL 10gdL gdL 10g dL g 27 P 5,5mg/dL 55mgdL mgdL 5 5mg mg 30 30% 171 17 17,1% Conclusões aumentar diminuiu baixa estimativas 20 (SBN 2 24 15383 15 83 153.83 21 9 95, 4, (DP 1, COVID1 COVID-1 17,1 1538 8 153.8 COVID- 17, 153.

ABSTRACT The desperate attempt to improve mortality, morbidity, quality of life and patient-reported outcomes in patients on hemodialysis has led to multiple attempts to improve the different modes, frequencies, and durations of dialysis sessions in the last few decades. Nothing has been more appealing than the combination of diffusion and convection in the form of hemodiafiltration. Despite the concrete evidence of better clearance of middle weight molecules and better hemodynamic stability, tangible evidence to support the universal adoption is still at a distance. Survival benefits seen in selected groups who are likely to tolerate hemodiafiltration with better vascular access and with lower comorbid burden, need to be extended to real life dialysis patients who are older than the population studied and have significantly higher comorbid burden. Technical demands of initiation hemodiafiltration, the associated costs, and the incremental benefits targeted, along with patient-reported outcomes, need to be explored further before recommending hemodiafiltration as the mode of choice. mortality morbidity patientreported patient reported modes frequencies decades stability distance burden costs targeted choice

RESUMO A tentativa desesperada de melhorar a mortalidade, morbidade, qualidade de vida e desfechos relatados pelos pacientes em indivíduos em hemodiálise levou a diversas tentativas de aprimorar os diferentes modos, frequências e durações das sessões de diálise nas últimas décadas. Nada foi mais atrativo do que a combinação de difusão e convecção na forma de hemodiafiltração. Apesar das evidências concretas de melhor depuração de moléculas de peso médio e melhor estabilidade hemodinâmica, evidências tangíveis para apoiar a adoção universal ainda estão distantes. Os benefícios de sobrevida observados em grupos selecionados que provavelmente toleram a hemodiafiltração com melhor acesso vascular e com menor carga de comorbidades precisam ser estendidos aos pacientes reais em diálise, que são mais velhos do que a população estudada e apresentam uma carga de comorbidades significativamente maior. As exigências técnicas do início da hemodiafiltração, os custos associados e os benefícios incrementais almejados, juntamente com os desfechos relatados pelos pacientes, precisam ser melhor explorados antes de se recomendar a hemodiafiltração como o modo de escolha. mortalidade morbidade modos décadas hemodinâmica distantes maior almejados escolha

Abstract Objective: The aim of this study was to estimate whether the consumption of anticoagulants was associated with a difference in the frequency of thrombosis of any site, major bleeding and mortality, in adults with both diseases. Method: A retrospective cohort study was carried out in four high complexity centers. Patients older than 18 years with CKD on hemodialysis and non-valvular AF, with an indication for anticoagulation (CHA2DS2VASc ≥ 2), were included. The primary outcome was the occurrence of: major bleeding, thrombotic event (cerebrovascular accident, acute myocardial infarction or venous thromboembolic disease) or death. Adjustment for confounding variables was performed using logistic regression. Results: From 158 patients included, 61% (n = 97) received an anticoagulant. The main outcome was found in 84% of those who received anticoagulation and 70% of those who did not (OR: 2.12, 95%CI: 0.98-4.57; after the adjusted analysis OR: 2.13, 95%CI: 1.04-4.36). Separate outcomes were bleeding in 52% vs. 34% (OR: 2.03; 95%CI: 1.05-3.93), thrombosis in 35% vs. 34% (OR: 1.03; 95%CI: 0.52-2-01) and death in 46% vs. 41% (OR: 1.25; 95%CI: 0.65-2.38). Conclusions: The results of this study suggest an increased risk of bleeding in patients with AF and CKD on hemodialysis receiving anticoagulation, without a decrease in the risk of thrombotic events or all-cause mortality.

Resumen Objetivo: El objetivo de este estudio fue estimar si el uso de anticoagulantes se asociaba con una diferencia en la frecuencia de trombosis de cualquier sitio, hemorragia mayor y mortalidad en adultos con coexistencia de ambas patologías. Método: Se realizó un estudio de cohorte retrospectivo en cuatro centros de alta complejidad. Se incluyeron mayores de 18 años con ERC en hemodiálisis y FA no valvular, con indicación de anticoagulación (CHA2DS2VASc ≥ 2). El desenlace primario fue la ocurrencia de sangrado mayor, evento trombótico (accidente vascular cerebral, infarto agudo al miocardio o enfermedad tromboembólica venosa) o muerte. Se realizó ajuste por variables de confusión por regresión logística. Resultados: De los 158 pacientes incluidos, el 61% (n = 97) recibieron anticoagulante. El desenlace principal se encontró en el 84% de quienes recibieron anticoagulación y en el 70% de quienes no la recibieron (OR: 2.12, IC95%: 0.98-4.57; luego del ajuste OR: 2.13, IC95%: 1.04-4.36). De los desenlaces mayores se presentaron sangrado en el 52% vs. el 34% (OR: 2.03; IC95%: 1.05-3.93), trombosis en el 35% vs. el 34% (OR: 1.03; IC95%: 0.52-2.01) y muerte en el 46% vs. el 41% (OR: 1.25; IC95%: 0.65-2.38). Conclusiones: Los resultados de este estudio sugieren un incremento en el riesgo de sangrado en los pacientes con FA y ERC en hemodiálisis que reciben anticoagulación, sin disminución del riesgo de eventos trombóticos ni de muerte.

ABSTRACT Background: Hemodialysis is a procedure in which the primary caregiver is not actively involved; however, he or she suffers emotional disturbances due to the workload of caring for the patient. Objective: Identify the prevalence of primary caregiver overload in renal replacement therapy with hemodialysis. Materials and methods: Descriptive cross-sectional study, January-December 2021, in a Regional General Hospital, among caregivers of patients with kidney disease on hemodialysis, over 18 years of age, both sexes. Caregivers who received payment for services was excluded. Their weight, height, blood pressure, sociodemographic variables and care time were measured, and the Zarit caregiver burden scale was applied for primary caregivers. Results: One hundred primary caregivers were surveyed (28% men, 72% women), with an average age of 49 ± 14.6 years. In the relationship, 40% children. Eighty-six per cent had been caregivers for more than six months. They presented mild (12%) and intense (7%) caregiver overload. Conclusions: Primary caregivers of patients on renal replacement therapy with hemodialysis assigned to the General Hospital of Zone No. 2, in Zacapu, Michoacan, has a prevalence of overload of 19%. This is presented in a considerable number of family members, hence the importance of addressing the mental and physical health not only of the patient but also of the primary caregiver.

RESUMEN Antecedentes: La hemodiálisis es un procedimiento en el cual el cuidador primario no se involucra activamente, sin embargo sufre alteraciones emocionales derivadas de la carga de trabajo en el cuidado del paciente. Objetivo: Identificar la prevalencia de sobrecarga del cuidador primario en terapia renal sustitutiva con hemodiálisis. Material y métodos: Estudio transversal descriptivo, enero-diciembre 2021, en un Hospital General de Zona, a cuidadores de pacientes con enfermedad renal en hemodiálisis, mayores de 18 años, ambos sexos. Se excluyeron cuidadores que recibían pago por servicios. Se les midió peso, talla, presión arterial, variables sociodemográficas y tiempo de cuidado, y se aplicó escala de carga del cuidador de Zarit para cuidadores primarios. Resultados: Se encuestaron 100 cuidadores primarios (28% hombres, 72% mujeres), con edad promedio 49 ± 14.6 años. En el parentesco, 40% hijos. El 86% tenían más de seis meses de ser cuidadores. Presentaron sobrecarga del cuidador leve (12%) e intensa (7%). Conclusiones: Los cuidadores primarios de los pacientes en terapia renal sustitutiva con hemodiálisis adscritos al Hospital General de Zona No. 2, en Zacapu, Michoacán, presentan una prevalencia de sobrecarga del 19%. Se presenta en una cantidad considerable de familiares, de ahí la importancia de atender la salud mental y física no solo del paciente, sino también del cuidador primario.

ABSTRACT Introduction: Collar of Stokes is part of the clinical picture of Superior Vena Cava Syndrome. Patients who require hemodialysis need vascular access by placing a double-lumen catheter in the jugular or subclavian veins, which, when used for long periods of time, can favor the appearance of face/neck edema. Objective: To present a patient on hemodialysis with collar of Stokes edema, taking into account that it is a rarely discussed cause of edema. Clinical Case: Male patient, 26 years old, black skin color, apparent health history who arrives at the emergency room with a hypertensive emergency. Complementary tests showed elevated blood creatinine and urea with renal ultrasound showing small kidneys; He was considered a patient with chronic renal failure. Periodic intermittent hemodialysis treatment was started, which was maintained for 29 months until the time of evaluation. With multiple double-lumen catheters to receive the cleansing treatment, he developed gradual volume increase in his facial and neck region. Conclusion: The use of double-lumen catheters for hemodialysis can favor the appearance of collar of Stokes edema; which may be seen more frequently due to the accessibility of patients with stage 5 chronic kidney disease to conventional hemodialysis.

RESUMEN Introducción: El edema en esclavina forma parte del cuadro clínico del síndrome de la vena cava superior. Los pacientes que requieren de hemodiálisis necesitan de un acceso vascular colocando un catéter de doble luz en las venas yugular o subclavia que, utilizado por periodos prolongados de tiempo, puede favorecer la aparición de edema en esclavina. Objetivo: Presentar a un paciente en hemodiálisis con edema en esclavina, teniendo en cuenta que es una causa de edema poco comentada. Caso Clínico: Paciente masculino, 26 años de edad, color de piel negra, antecedentes de salud aparente que llega al cuerpo de guardia con una emergencia hipertensiva. Se le realizaron complementarios que mostraron creatinina y urea en sangre elevadas con ecografía renal que mostraba riñones pequeños; se consideró un paciente con insuficiencia renal crónica. Se inició tratamiento de hemodiálisis periódica intermitente, que se mantuvo por 29 meses hasta el momento de su valoración. Con múltiples catéteres de doble luz para recibir el tratamiento depurador, desarrolló aumento de volumen gradual de la región facial y el cuello. Conclusión: El uso de catéteres de catéteres de doble luz para hemodiálisis, por periodos prolongados, pueden favorecer la aparición de edema en esclavina.