Cristiane Rickli

Chronic kidney disease (CKD) has been increasing globally, with hemodialysis (HD) being the most commonly used treatment. However, HD can lead to episodes of hypotension, affecting cerebral perfusion and intracranial pressure (ICP), potentially compromising cerebral compliance. In this context, non-invasive ICP monitoring becomes a valuable tool for the early detection of such changes. This report describes a 58-year-old patient on HD for three years, whose cerebral compliance was assessed before and after dialysis sessions. A significant reduction in systolic blood pressure (SBP) was observed, possibly influencing ICP dynamics and the P2/P1 ratio. Since HD can cause osmotic imbalances and cardiovascular effects that impact cerebral perfusion, continuous ICP monitoring using non-invasive methods may enhance clinical management and reduce neurological risks in individuals with CKD.

Among the complications related to chronic kidney disease (CKD), those of a neurological nature stand out, and for a better quality of life for patients, the diagnosis and treatment of these complications is fundamental.

Population aging is reality and indicates the need for a better quality of life. Aging brings loss of functions, neurological changes and comorbidities. Studies have sought to reduce the progression of diseases in the elderly and some suggest diseases may have their development related to high intracranial pressures (ICP). The aim of this study was to evaluate for the first time ICP morphology in residents of a Long-Term Institution for the Elderly, using a non-invasive technology. Of the 91 elderly people evaluated, 88% had ICP alterations, 58% are dependent to daily activities, 23% are wheelchair users and 79% have a mental state as compromised. As for comorbidities, frequently identified chronic-degenerative diseases were arterial hypertension (50%), depression (27%), diabetes (24%) and dementia (14%), in addition to polypharmacy. There was a significant difference in the prevalence of altered ICP for wheelchair users and for residents who do not walk . A high rate of altered ICP was observed in the population studied, highlighting the importance of assessing intracranial compliance in understanding the aging and future follow-up studies of the elderly at different stages of diseases, especially neurological ones.

In the course of cardiac surgery with cardiopulmonary bypass (CPB) many factors come into play. A lot of care is needed, in addition to the surgery itself, especially with regard to blood oxygenation, blood pressure and the formation of microemboli, which will directly influence the pathogenesis of neurological abnormalities found in the postoperative period. Elevations in the values ​​of intracranial pressure (ICP) in adults can be small to severe, and may pose a threat to the patient's life, according to this increase. The objective of the present study is to discuss possible changes in the ICP of patients who underwent cardiac surgery as possible consequences of CPB. Since perfusion triggers the Systemic Inflammatory Response Syndrome, directly and indirectly interfering with the mechanisms that maintain brain compliance, such changes in ICP may occur as a consequence of CPB, however, investigations are needed to explain this possible relationship.

The high number of patients with end-stage kidney disease (ESRD) on hemodialysis makes it necessary to conduct studies aimed at improving their quality of life. To evaluate brain compliance, using the Brain4care method for intracranial pressure (ICP) monitoring, among patients with ESRD before and at the end of the hemodialysis session, and to correlate ICP with the dialysis quality index (Kt/V). Cross-sectional study conducted at a renal replacement therapy center in Brazil. Sixty volunteers who were undergoing hemodialysis three times a week were included in this study. Brain compliance was assessed before and after hemodialysis using the noninvasive Brain4care method and intracranial pressure wave morphology was analyzed. Among these 60 ESRD volunteers, 17 (28%) presented altered brain compliance before hemodialysis. After hemodialysis, 12 (20%) exhibited normalization of brain compliance. Moreover, 10 (83%) of the 12 patients whose post-dialysis brain compliance became normalized were seen to present good-quality dialysis, as confirmed by Kt/V > 1.2. It can be suggested that changes to cerebral compliance in individuals with ESRD occur frequently and that a good-quality hemodialysis session (Kt/V > 1.2) may be effective for normalizing the patient’s cerebral compliance.

Realizou-se uma pesquisa retrospectiva através de registros dos 195 prontuários dos pacientes de uma unidade de tratamento dialítico na cidade de Campo Mourão-PR, com o objetivo de traçar o perfil epidemiológico dos pacientes que tiveram atendimento entre os meses de janeiro a agosto de 2020. O elevado número de indivíduos com doença renal crônica (DRC) tem aumentado anualmente, entre as principais causas destacam-se a hipertensão arterial sistêmica (HAS) e o diabetes mellitus (DM). Após a total paralisação das funções renais, é necessário o tratamento dialítico, seja por hemodiálise ou diálise peritoneal, para retirar o excesso de líquidos e catabólitos. Foi possível observar em 195 pacientes avaliados que a etiologia da DRC que mais se destaca é a HAS (46,67%), seguido de DM (35,38%), com predomínio do sexo masculino e faixa etária entre 61 a 70 anos (26,15%). Podemos evidenciar que a hipertensão arterial sistêmica e o diabetes mellitus, são as principais doenças de base para DRC, sendo necessária a elaboração de políticas públicas para conscientizar e prevenir a população de risco sobre a necessidade de acompanhamento médico dos fatores de risco descritos.