Helbert Do Nascimento Lima

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Objetivo: Comparar as características e a sobrevida de pessoas idosas com sepse com ou sem injúria renal aguda. Metodologia: Coorte retrospectiva em uma unidade de terapia intensiva de um hospital privado de Joinville (SC), Brasil, entre dezembro de 2017 e agosto de 2021. Incluíram-se pessoas idosas (com 60 anos ou mais) com diagnóstico de sepse. A ocorrência de injúria renal aguda (IRA) com ou sem necessidade dialítica, em comparação com aqueles sem IRA, foi avaliada quanto ao risco de óbito em 30 dias, por meio de regressão multivariada de Cox, ajustada para idade (modelada por restricted cubic splines) e variáveis clínicas relevantes. Resultados: Dos 690 pacientes, 49,4% apresentaram IRA, destes, 14,2% necessitaram de hemodiálise. Pacientes com IRA e necessidade de hemodiálise apresentavam valores mais altos de creatinina na admissão, bem como de proteína C reativa, escore de gravidade SAPS-3, maior uso de ventilação mecânica, drogas vasoativas e corticoide. A sobrevida em 30 dias foi de 73,8% para pacientes sem IRA, 48,6% para aqueles com IRA sem necessidade de hemodiálise e 56,8% para IRA com hemodiálise (teste de Log-Rank, p < 0,001). Na análise multivariada, a IRA sem necessidade de diálise permaneceu associada a maior risco de óbito em 30 dias (HR 2,33; IC95% 1,55 – 3,49; p < 0,001), enquanto a IRA com necessidade de diálise não apresentou associação significativa (HR 1,32; IC95% 0,80 – 2,15; p = 0,275). A idade não modificou o efeito da IRA sobre a mortalidade. Conclusão: Em pessoas idosas com sepse, IRA sem necessidade de diálise associou-se a maior risco de mortalidade, já a IRA dialítica não se associou a maior risco de óbito, o que possivelmente reflete diferenças no perfil clínico e na gravidade entre os subgrupos.

Objective: To compare the characteristics and survival rates of older patients with sepsis with and without acute kidney injury (AKI). Methods: This retrospective cohort study included older patients (aged ≥ 60 years) admitted to the intensive care unit of a private hospital in Joinville, SC, Brazil, from December 2017 to August 2021, with a diagnosis of sepsis. Patients with AKI, with or without the need for dialysis, were compared with those without AKI regarding 30-day mortality. Multivariate Cox regression analysis was performed, adjusted for age (modeled using restricted cubic splines) and relevant clinical variables. Results: Of 690 patients, 49.4% had AKI, 14.2% of whom required hemodialysis. Patients with AKI requiring dialysis had higher creatinine and C-reactive protein levels at admission, higher SAPS-3, increased need for mechanical ventilation, and more frequent use of vasoactive drugs and corticosteroids. Among patients without AKI, 30-day survival was 73.8%, compared with 48.6% in patients with AKI not requiring dialysis and 56.8% in those requiring dialysis (log-rank p < 0.001). In multivariate analysis, AKI not requiring dialysis remained associated with increased risk of 30-day mortality (hazard ratio [HR] 2.33; 95% CI, 1.55–3.49; p < 0.001), whereas AKI requiring dialysis was not significantly associated (HR 1.32; 95% CI, 0.80–2.15; p = 0.275). Age did not change the effect of AKI on mortality. Conclusion: In older patients with sepsis, AKI not requiring dialysis was associated with increased risk of mortality, whereas AKI requiring dialysis was not. This finding may reflect differences in clinical characteristics and disease severity between these patient subsets.

Resumo Introdução: O Censo Brasileiro de Diálise (CBD) anual desempenha papel fundamental na informação e definição de políticas nacionais de saúde. Métodos: Realizou-se pesquisa entre centros brasileiros de diálise crônica por participação voluntária, utilizando questionário online para avaliar características clínicas e epidemiológicas de pacientes em diálise e atributos dos centros. Para estimar a prevalência, a incidência e a fonte de financiamento, foi selecionada uma amostra aleatória nacionalmente representativa de centros de diálise, estratificada por região geográfica. (n = 258). Resultados: Um total de 386 centros de diálise (42,7%) respondeu voluntariamente ao questionário online e 162 centros dentre os selecionados aleatoriamente forneceram dados. Em 1º de julho de 2024, o número estimado de pacientes em diálise era 172.585, com 52.944 novos pacientes iniciando diálise em 2024. Taxas estimadas de prevalência e incidência por milhão da população (pmp) foram 812 e 249, respectivamente. Entre pacientes prevalentes, 87,3% estavam em hemodiálise, 7,1% em hemodiafiltração, 5,6% em diálise peritoneal. Comparado ao ano anterior, houve aumento no uso de cateteres para acesso vascular de hemodiálise, juntamente com maiores taxas de prevalência de anemia, hiperfosfatemia, hiperpotassemia e baixo Kt/V. A taxa bruta estimada de mortalidade anual foi 16,5%. Conclusões: Dados de uma amostra aleatória de centros de diálise indicam aumento contínuo no número e prevalência de pacientes em diálise crônica no Brasil. Piores tendências em relação ao acesso vascular, adequação da diálise e controle metabólico ressaltam a necessidade de melhorias direcionadas ao cuidado dos pacientes.

Introduction: The annual Brazilian Dialysis Survey (BDS) plays an important role in informing and shaping national health policies. Objective: To present the 2024 epidemiological findings from the BDS conducted by the Brazilian Society of Nephrology (BSN) and compare them with previous years. Methods: A survey was conducted among Brazilian chronic dialysis centers through voluntary participation, utilizing an online questionnaire to assess clinical and epidemiological characteristics of dialysis patients, as well as dialysis center attributes. For specific estimates of prevalence, incidence, and funding source, a nationally representative random sample of dialysis centers stratified by geographic region was selected (n = 258). Results: A total of 386 dialysis centers (42.7%) voluntarily responded to the online questionnaire, and 162 centers from the randomly selected centers provided data. On July 1st, 2024, the estimated number of dialysis patients was 172,585, with 52,944 new patients starting dialysis in 2024. The estimated prevalence and incidence rates per million population (pmp) were 812 and 249, respectively. Among prevalent patients, 87.3% were undergoing hemodialysis, 7.1% hemodiafiltration, and 5.6% peritoneal dialysis. Compared to the previous year, there was an increase in catheter use for hemodialysis vascular access, along with higher prevalence rates of anemia, hyperphosphatemia, hyperkalemia, and low Kt/V. The estimated crude annual mortality rate was 16.5%. Conclusions: Data from a random sample of dialysis centers indicate a continued rise in the number and prevalence of chronic dialysis patients in Brazil. Worsening trends in permanent vascular access, dialysis adequacy, and metabolic control underscore the need for targeted improvements in patient care.

For 25 years, the Brazilian Society of Nephrology has systematically monitored chronic dialysis care through the Brazilian Dialysis Survey, offering a unique perspective on the evolution of dialysis practices and access to treatment in a large and diverse middle-income country. Analysis of data from 1999 to 2024 reveals that hemodialysis has remained the dominant modality, representing on average 92% of treatments, while peritoneal dialysis (PD) accounted for only 8% and showed a steady decline. Regional differences have been marked: the Northeast consistently reported the lowest rates of PD, while the South maintained above-average use. Funding sources also reflect broader structural dynamics in the health system. The Unified Health System (Sistema Único de Saúde) has been the backbone of dialysis provision, covering 83% of patients over the period. Yet, the role of private health insurance has expanded, with coverage increasing from 12% in 2006–2009 to 20% in 2019–2024. Interestingly, regional comparisons show contrasting patterns, with private insurance supporting a disproportionately high share of dialysis in the North compared with the general population, while in the Southeast, the opposite scenario was observed. Taken together, these findings illustrate a landscape shaped by declining use of PD, heavy reliance on public financing, and persistent regional inequities. Beyond documenting numbers, the Brazilian Dialysis Survey highlights the need for policies that promote equity, strengthen the role of PD, and ensure sustainable access to KRTs for all Brazilians.

To evaluate barriers and predictors for physical activity in hemodialysis patients in a Cross-sectional study of hemodialysis patients in Joinville/SC. Physically inactive patients and physically active patients were defined using the Godin Leisure-Time Exercise questionnaire. Of the 107, 19 (17.8%) were physically active. Fatigue, fear of injury, and financial constraints were the most cited barriers among the physically inactive. Increasing age (OR = 0.90; P = 0.001), time on hemodialysis (OR = 0.99; P = 0.016), and number of barriers (OR = 0.61; P = 0.004) were associated with a greater chance of physical inactivity. In conclusion, elderly patients with longer hemodialysis vintage and with a greater number of barriers represent a population at greater risk for physical inactivity.

Background: Dengue remains a major public health concern in Brazil, with approximately 6 million cases and over 6,000 deaths reported in 2024. Joinville, in southern Brazil, recorded one of the highest incidence rates in the country. Understanding the clinical and demographic factors associated with dengue-related mortality in this region is essential for developing effective interventions. Methods: We conducted a retrospective matched case-control study using data from the Sistema de Informação de Agravos de Notificação database, involving adult patients with dengue who presented with warning signs or severe disease and were treated within Joinville's public health system (Sistema Único de Saúde) between January 2021 and December 2024. Cases were defined as fatal outcomes, while controls were matched survivors. Univariate and multivariate logistic regression models were used to estimate mortality risk. Results: Among 454 patients, 116 (26%) were cases and 336 (74%) were controls. Lower mortality was associated with having ≥ 2 medical consultations (odds ratio [OR] = 0.20; 95% confidence interval [CI]: 0.10-0.51) and receiving intravenous hydration of ≥ 1 L (OR = 0.32; 95% CI: 0.14-0.72). Hypotension (OR = 3.06; 95% CI: 1.33-7.03), thrombocytopenia (OR = 2.47; 95% CI: 1.21-5.02), and lethargy or irritability (OR = 15.59; 95% CI: 6.50-37.38) were significantly associated with mortality. Conclusions: Early intravenous rehydration and repeated clinical evaluations were associated with reduced mortality. Close monitoring of patients with warning signs is crucial for improving outcomes in high-incidence settings.

Resumo Introdução: A hiperglicemia de estresse em pacientes com sepse não tem sido consistentemente associada a um risco aumentado de injúria renal aguda (IRA). Objetivo: Avaliar o efeito dos níveis glicêmicos na ocorrência de IRA com necessidade dialítica em pacientes críticos com sepse. Métodos: Coorte histórica de pacientes com sepse, admitidos na UTI de um hospital privado entre dezembro de 2017 e agosto de 2021. Foram coletadas variáveis clínicas, laboratoriais e de gravidade. Os valores médios da glicemia na primeira semana de UTI (variável de exposição principal) foram estratificados pelos seus tercis. Avaliou-se o efeito da glicemia para a ocorrência de IRA dialítica por meio de regressão logística multivariada. Resultados: Dos 1317 pacientes avaliados, 86,6% apresentaram situações clínicas como causa de sepse. IRA com necessidade de hemodiálise ocorreu em 12,2% da amostra. Pacientes com médias de glicemia acima do terceiro tercil (≥160 mg/dl), em comparação àqueles com médias de glicemia abaixo dos dois primeiros tercis (<160 mg/dl), tinham maior prevalência de diabetes (69,1% vs. 7,1%; p < 0,001). Pacientes com médias de glicemia ≥160 mg/dl apresentaram uma chance 62% maior de desenvolver IRA com necessidade dialítica, em comparação àqueles com médias de glicemia <160 mg/dl (OR bruto = 1,62; IC 95% 1,16–2,26; p = 0,005). Após ajuste para as demais variáveis, valores médios de glicemia ≥180 mg/dl não aumentaram a chance de ocorrência de IRA (OR = 1,27; IC 95% 0,76–2,12; p = 0,359). Conclusão: Neste grupo de pacientes, a sepse e níveis médios de glicemia ≥160 mg/dl não foram independentemente associados à ocorrência de IRA dialítica.

Introduction: Stress hyperglycemia in patients with sepsis has not been consistently associated with an increased risk of acute kidney injury (AKI).