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.

RESUMO Introdução: Tem sido sugerido que os níveis de cistatina C são modificados pela obesidade e inflamação. Além disso, a cistatina C tem sido associada a eventos cardiovasculares e desfechos de mortalidade. Objetivo: Estudar a associação da cistatina C com o perfil metabólico e doença cardiovascular de pacientes em diálise peritoneal. Métodos: Os dados coletados incluíram avaliação clínica, laboratorial e de bioimpedância múltipla de 52 pacientes estáveis em diálise peritoneal. A função renal residual mínima foi definida como > 2mL/min/1,73m2. Resultados: A cistatina C sérica não esteve significativamente associada à excreção peritoneal ou urinária. A correlação negativa da cistatina C com a taxa catabólica protéica normalizada (rho -0,33, p = 0,02) e uma tendência de correlação positiva com a gordura corporal relativa (rho 0,27, p = 0,05) não foram independentes da função renal residual. A cistatina C não se associou significativamente à doença cardiovascular (p = 0,28), nem com hemoglobina glicada (p = 0,19) ou proteína C reativa (p = 0,56). No modelo multivariado, idade e diabetes foram os mais fortes preditores de doença cardiovascular (razões de probabilidade 1,09, p = 0,029 e 29,95, p = 0,016, respectivamente) enquanto a gordura corporal relativa se associou negativamente à doença cardiovascular (p = 0,038). A cistatina C não se associou significativamente com doença cardiovascular (p = 0,096), tampouco a função residual mínima (p = 0,756). Conclusão: Neste grupo de pacientes em diálise peritoneal, a cistatina C não se correlacionou com o estado metabólico ou inflamatório, nem com doença cardiovascular, após ajuste para função renal residual.

ABSTRACT Introduction: It has been suggested that cystatin C levels are modified by obesity and inflammation. Furthermore, cystatin C has been associated with cardiovascular events and mortality outcomes. Aim: To study the association of cystatin C with the metabolic profile and cardiovascular disease of peritoneal dialysis patients. Methods: Data collected included clinical, laboratorial, and multifrequency bioimpedance assessment of 52 stable peritoneal dialysis patients. Minimal residual renal function was defined as > 2mL/min/1.73m2. Results: Serum cystatin C was not significantly associated with peritoneal or urinary cystatin C excretion. Negative correlation of cystatin C with normalized protein catabolic rate (rho -0.33, p = 0.02) and a trend towards positive correlation with relative body fat (rho 0.27, p = 0.05) were not independent from residual renal function. Cystatin C was not significantly associated with cardiovascular disease (p = 0.28), nor with glycated hemoglobin (p = 0.19) or c-reactive protein (p = 0.56). In the multivariate model, both age and diabetes were the strongest predictors of cardiovascular disease (odds ratio 1.09, p = 0.029 and odds ratio 29.95, p = 0.016, respectively), while relative body fat was negatively associated with cardiovascular disease (p = 0.038); neither cystatin C (p = 0.096) nor minimal residual renal function (p = 0.756) reached a significant association with cardiovascular disease. Conclusions: In this group of peritoneal dialysis patients, cystatin C did not correlate with the metabolic or inflammatory status, nor cardiovascular disease, after adjustment for residual renal function.

Background and objectives: Hypervolemia is a major concern in dialysis patients, and is associated with increased cardiovascular risk and death. Cross sectional analysis have previously demonstrated that peritoneal dialysis (PD) patients are not more overhydrated when compared to haemodialysis' ones. This study was designed to evaluate longitudinal trends in hydration status and corporal composition in a PD population. Methods: We conducted a 2 year prospective observational study of 58 PD patients from a single centre. Incident and prevalent patients were included. Yearly measurements were performed using multifrequency electric bioimpedance. Overhydration (OH) was defined as an extra-cellular water (ECW)/total body water (TBW) over 15%. Clinical and biochemical variables were also explored. Results: A total of 30 patients completed evaluation (female 63.3%, mean age 56.9 years, BMI 25.0 kg/m², diabetes 10.0%, APD-50.0%). Median PD vintage was 21.9 months, and 36.7% were anuric. At baseline 6.7% were overhydrated. On longitudinal analysis no significant changes were found in hydration status, systolic blood pressure, pro-BNP, nor albumin levels. Similar results were found among incident (n=11; APD- 45.5%; anuric- 9.1%) and prevalent (n=19; APD- 52.6%; anuric- 52.6%) patients (p>.05). However, at the second year, prevalent patients were moderately overhydrated compared to incident ones (median 10.2% vs 3.5%; p=.009). Nonetheless, no statistical difference was observed considering adequacy, TBW, or ECW. Moreover, nutritional parameters remained stable. Conclusions: Peritoneal dialysis maintenance without increasing volume status, nor major deleterious corporal composition trends, is feasible under careful therapy strategies. Longitudinal application of BIA may be a useful clinical tool to evaluate adequacy beyond Kt/V.

Antecedentes y objetivos: La hipervolemia constituye un gran problema en los pacientes de diálisis, y se asocia a un incremento del riesgo cardiovascular y muerte. Los análisis transversales han demostrado previamente que los pacientes de diálisis peritoneal (DP) no sufren de sobrehidratación, en comparación a los pacientes de hemodiálisis. Este estudio fue diseñado para evaluar las tendencias longitudinales de composición corporal e hidratación en una población de pacientes de DP. Métodos: Realizamos un estudio observacional prospectivo de dos años a 58 pacientes de DP de un único centro. Se incluyó pacientes incidentales y prevalentes. Se realizaron mediciones anuales utilizando bioimpedancia eléctrica de multi-frecuencia. La sobrehidratación se definió como el ratio agua extra-celular (ECW)/agua corporal total (ACT) superior al 15%. También se exploraron variables clínicas y bioquímicas. Resultados: Un total de 30 pacientes completarán el estudio (mujeres: 63,3%, edad media 56,9 años, IMC 25,0 kg/m², diabetes 10,0%, DPA-50,0%). La antigüedad media de DP fue de 21,9 meses, y el 36,7% padecía anuria. Al inicio, el 6,7% padecía sobrehidratación. En los análisis longitudinales no se hallaron cambios en cuanto a hidratación, presión sanguínea sistólica, pro-BNP, o niveles de albúmina. Se hallaron resultados similares entre los pacientes incidentales (n = 11; APD- 45,5%; anuria- 9,1%) y prevalentes (n = 19; DPA- 52,6%; anuria- 52,6%) (p > 0,05). Sin embargo, al segundo año, los pacientes prevalentes estaban moderadamente sobrehidratados en comparación con los incidentales (media 10,2% frente a 3,5%; p = 0,009). En cambio, no se observó una diferencia estadística en cuanto a adecuación, ACT, o ECW. Además, los parámetros nutricionales permanecieron estables. Conclusiones: La prevalencia de la diálisis peritoneal sin incremento de volumen ni alteración de los índices de composición corporal es factible si se aplican estrategias terapéuticas prudentes. La aplicación longitudinal de BIA puede constituir una herramienta clínica para evaluar la adecuación por encima de Kt/V.

Background: Sexual function, psychosocial status and quality of life (QoL) are important dimensions, often underestimated, in dialysis treatment schedules. Objectives: The aim of this study was to evaluate the prevalence of sexual dysfunction and its associations, among peritoneal dialysis (PD) patients. Methods: The Index of Female Sexual Function (IFSF), the International Index of Erectile Function (IIEF), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life EQ5D questionnaires were applied to a prevalent PD population of 57 enrolled patients. Multivariate analysis was conducted to investigate clinical independent risk factors for sexual dysfunction. Results: Sexual dysfunction was diagnosed in 67.9% of women and 44.8% of men. In females, serum albumin, creatinine and phosphorus levels and EQ5D positively correlated with IFSF score. For males, there was a significant negative correlation between serum calcium levels and the IIEF score. On multivariate analysis, nutritional parameters remained independently associated with sexual dysfunction in women; in males, increase in calcium concentration and decrease of testosterone were main determinants. On logistic regression analysis, the risk of sexual dysfunction in global population was associated with lower values of albumin (OR=6.94) and with a lower QoL score EQ5D (OR=6.93). Conclusions: Sexual dysfunction is highly prevalent and strongly associated with impaired QoL of PD patients. Different clinical variables were related to sexual dysfunction in each gender, justifying an individualized preventive and therapeutic approaches.

Introducción: La sexualidad, el estatus psicosocial y la calidad de vida (QoL) son factores importantes, a menudo infravalorados, en los esquemas de diálisis. Objetivos: Evaluar la prevalencia de disfunción sexual y sus asociaciones en los pacientes en diálisis peritoneal (DP). Métodos: Se utilizaron el Índice de Función Sexual Femenina (IFSF), el Índice Internacional de Función Eréctil (IIFE), la Escala de Ansiedad y Depresión Hospitalaria (HADS) y los cuestionarios sobre calidad de vida EQ5D en la población prevalente en DP (57 pacientes). Se realizaron análisis multivariantes para investigar los factores clínicos independientes para disfunción sexual. Resultados: Se diagnosticó disfunción sexual en el 67,9 % de las mujeres y en el 44,8 % de los varones. En las mujeres la albúmina sérica, la creatinina, los niveles de fósforo y EQ5D se relacionaran positivamente con IFSF. En los varones existía una correlación negativa entre el calcio sérico y el score IIEF. En el análisis multivariante los parámetros nutricionales permanecieron asociados de manera independiente con la disfunción sexual en mujeres; en los varones los principales determinantes fueron el aumento de la concentración de calcio y la disminución de la testosterona. En los análisis de regresión logística el riesgo de disfunción sexual en la población global está asociado a niveles menores de albúmina (OR = 6,94) y a un score inferior de EQ5D (OR = 6,93). Conclusiones: La disfunción sexual tiene una alta prevalencia y una fuerte asociación con la percepción de la calidad de vida de los pacientes en DP. Se han encontrado diferentes variables clínicas relacionadas con la disfunción sexual en cada sexo que justifican actitudes preventivas y terapéuticas individualizadas.

Dentre os organismos que atuam no controle biológico natural dos tefritídeos, os representantes da família Braconidae constituem-se no mecanismo de parasitismo natural mais atuante, e na região Neotropical, representantes de Opiinae são os principais agentes de controle de Anastrepha. Este trabalho teve por objetivo conhecer a percentagem de parasitismo e as espécies de braconídeos associados às fruteiras cultivadas em municípios da região Litoral Sul da Bahia. No período de agosto de 2005 a março de 2008, coletaram-se frutos hospedeiros de moscas-das-frutas de diversas espécies botânicas, e dos frutos foram obtidas as seguintes espécies de Anastrepha: A. fraterculus, A. obliqua, A. bahiensis, A serpentina, A. sororcula e A. zenildae. Do total de 838 exemplares de braconídeos, 21,36% foram da espécie Utetes anastrephae (Viereck), provenientes de cajá, carambola, goiaba, manga e pitanga; 4,42% da espécie Asobara anastrephae (Muesebeck) obtidos dos frutos de cajá, carambola e goiaba, e apenas um exemplar da espécie Opius bellus Gahan (0,12%) que emergiu da amostra de goiaba. A espécie Doryctobracon areolatus (Szépligeti) (74,10%) foi predominante e emergiu dos pupários provenientes de todos os frutos hospedeiros coletados, provavelmente pela maior eficiência desta espécie em localizar as larvas dos tefritídeos. A percentagem média de parasitismo de Anastrepha spp. foi de 4,45%.

Among the organisms acting in the natural biological control of tephritids, members of the family Braconidae are the most active form of natural parasite, and in Neotropical regions, members of Opiinae are the main control agents of Anastrepha. The objective of this work was to discover the percentage of parasitism and the species of braconid associated with fruit trees growing in cities on the southern coast of Bahia. During the period of August, 2005 to March, 2008, hosts fruits of fruit flies from several plant species were collected and from the fruits the following species of Anastrepha were obtained: A. fraterculus, A. obliqua, A. bahiensis, A. serpentina, A. sororcula and A. zenildae. Of the total of 838 specimens of braconids, 21.36% were of the species Utetes anastrephae (Viereck), obtained from yellow mombin, carambola, guava, mango and pitanga; 4.42% were of the species Asobara anastrephae (Muesebeck) obtained from the fruits of the yellow mombin, carambola and guava, and only one example of Opius bellus Gahan (0.12%) that came from a guava sample. The species Doryctobracon areolatus (Szépligeti) (74.10%) was predominant and emerged from puparia from all the host fruits collected, probably due to the greater efficiency of this species in locating tephritid larvae. The mean percentage of parasitism by Anastrepha spp. was 4.45%.

Neste trabalho se estudaram o desenvolvimento e o estado nutricional de helicônias irrigadas com água residuária tratada de origem doméstica associada a fertilizantes químicos (NPK). O experimento foi conduzido em casa de vegetação na qual se utilizaram plantas de helicônia Golden Adrian. O experimento foi instalado no esquema fatorial 5 x 3 + 1 constituídos de cinco níveis de lâmina de água aplicada (equivalente a 60, 80, 100, 120 e 140% da evaporação do tanque classe A ECA), três tipos de água (água residuária (AR), água pluvial (AP) e mistura de 50% de AR + 50% de AP) e testemunha (solo sem adubação e recebendo 100% da ECA de água pluvial). O delineamento experimental utilizado foi blocos ao acaso, com cinco repetições. A utilização de AR e as lâminas maiores proporcionaram acréscimo nos parâmetros de crescimento avaliados. Os teores de macronutrientes presentes nas folhas das plantas irrigadas com AR se comportaram de forma semelhante às plantas que receberam AP. O uso de AR e AP resultou em acréscimo de teores de micronutrientes nas folhas, principalmente Fe e Mn, acima dos teores recomendados para a cultura.

In this study the growth and nutritional status of helicônias irrigated with treated wastewater of domestic origin associated with chemical fertilizers (NPK) was studied. The experiment was conducted in a greenhouse utilizing plants of helicônia Golden Adrian. The experiment was installed in 5 x 3 + 1 factorial scheme consisting of five depths of irrigation water (equivalent to 60, 80, 100, 120 and 140% of class A pan evaporation - ECA), three types of water (wastewater (AR), rainwater (AP) and a mixture of 50% AR + 50% AP) and control (soil without fertilizer and receiving rainwater corresponding to 100% ECA). The experimental design was in randomized blocks with five repetitions. The use of AR and larger depths of irrigation provided increases in evaluated parameters of growth. The levels of macronutrients in the leaves of plants irrigated with AR were similar to plants that received AP. The use of AR and AP resulted in increases in the content of micronutrients in leaves, especially Fe and Mn, above the levels recommended for the crop.