Mônica Ribeiro Canhestro

Predictive factors of progression to chronic kidney disease stage 5 in a predialysis interdisciplinary programme

BACKGROUND The clinical course of chronic kidney disease (CKD) in children is heterogeneous and has not been fully established. The aim of this retrospective cohort study was to identify predictive factors associated with the progression of CKD among the children and adolescents admitted to a Predialysis Interdisciplinary Management Programme (PDIMP). METHODS We analysed the following variables at admission: age, gender, race, blood pressure, primary renal disease, Z-scores for weight and height, CKD stage and degree of proteinuria. Two time-dependent covariates were considered: hypertension and proteinuria. CKD stage 5 was assigned as a dependent variable. Time-fixed and time-dependent Cox regression analyses were applied to evaluate renal survival. RESULTS One hundred and seven patients with CKD stage 2-4 were followed up for a median time of 94 months. Fifty-seven patients (53.3%) progressed to CKD stage 5. After adjustment for time-fixed model, three baseline variables were found to be independent predictors of CKD stage 5: glomerular disease (hazard ratio, HR = 3.0, P = 0.015), CKD stage 4 (HR = 2.6, P = 0.001) and severe proteinuria (HR = 4.1, P = 0.006). After adjustment for the time-dependent model, three variables were found to be independent predictors of CKD stage 5: proteinuria as time-dependent covariate (HR = 1.9, P = 0.041), CKD stage 4 (HR = 2, P = 0.0086) and baseline serum albumin <3.5 g/dl (HR = 2.6, P = 0.0015). CONCLUSIONS Taking into account manageable factors, further prospective controlled studies are necessary to assess intervention measures in order to possibly modify the clinical course of CKD in children.

Transtornos mentais e qualidade de vida em crianças e adolescentes com doença renal crônica e em seus cuidadores

In the last decades there was a striking improvement in survival of children with chronic kidney disease. As life expectancy has increased in children with CKD, concern has risen about its physical, psychological, and social consequences. The aim of this study was to perform a review of the psychological consequences of CKD in the pediatric population, with the focus on mental disorders and on quality of life. We also reviewed studies regarding emotional and social effects and their possible influences on treatment adhesion. Several studies have shown impairment on quality of life and on mental health of these patients. A better understanding of emotional consequences of CKD in pediatric population possibly can reduce the impact of the renal disease on children. Moreover, a comprehensive approach of children and adolescents with CKD might result in a better clinical control and improve treatment adhesion.

Letramento funcional em saúde e conhecimento de doentes renais em tratamento pré-dialítico

Objetivo: analisar o letramento funcional em saude (LFS) e o conhecimento sobre doenca renal cronica de 60 pacientes em tratamento pre-dialitico. Metodo: estudo transversal. O LFS foi mensurado pelo instrumento B-TOFHLA; e o conhecimento, por questionario. Foram realizados testes de correlacao de Pearson e Qui-quadrado e modelos de regressoes lineares. Resultados: todos entrevistados apresentaram LFS inadequado, e a maioria apresentou conhecimento insuficiente em relacao a doenca e ao tratamento. Menor escolaridade foi fator preditivo para piores escores de LFS. Conhecimento insuficiente foi relacionado a idade e ao comprometimento cognitivo. Conclusao: embora nao tenha sido encontrada associacao entre as variaveis preditivas, a limitada capacidade de obter e usar informacoes relacionadas a saude e o conhecimento insuficiente em relacao a propria doenca e tratamento podem contribuir para piores desfechos de DRC. Sao necessarias estrategias de intervencoes adequadas ao limitado LFS e maior conhecimento e habilidade dos profissionais para lidar com o assunto.Objective: to analyze the functional health literacy (FHL), i.e., understanding and knowledge about chronic renal disease of 60 patients in pre-dialytic treatment. Method: this is a cross-sectional study. FHL was measured by B-TOFHLA; and the knowledge, by questionnaire. Pearson correlation and Chi-square tests were carried out as well as linear regression models. Results: all respondents presented inadequate FHL, and most showed insufficient knowledge about the disease and treatment. Low schooling was a predictive factor for worst FHL scores. Insufficient knowledge was related to age and compromised cognition. Conclusion: although association between predictive variables has not been found, limited capability to obtain and use health-related information and insufficient knowledge about their own condition and treatment can contribute to worse outcomes for CKD. Appropriate intervention strategies are necessary to deal with limited FHL and also greater knowledge and ability of professionals to deal with the matter.

Alfabetización funcional en salud y el conocimiento de los pacientes renales en prediálisis

Objetivo: analisar o letramento funcional em saude (LFS) e o conhecimento sobre doenca renal cronica de 60 pacientes em tratamento pre-dialitico. Metodo: estudo transversal. O LFS foi mensurado pelo instrumento B-TOFHLA; e o conhecimento, por questionario. Foram realizados testes de correlacao de Pearson e Qui-quadrado e modelos de regressoes lineares. Resultados: todos entrevistados apresentaram LFS inadequado, e a maioria apresentou conhecimento insuficiente em relacao a doenca e ao tratamento. Menor escolaridade foi fator preditivo para piores escores de LFS. Conhecimento insuficiente foi relacionado a idade e ao comprometimento cognitivo. Conclusao: embora nao tenha sido encontrada associacao entre as variaveis preditivas, a limitada capacidade de obter e usar informacoes relacionadas a saude e o conhecimento insuficiente em relacao a propria doenca e tratamento podem contribuir para piores desfechos de DRC. Sao necessarias estrategias de intervencoes adequadas ao limitado LFS e maior conhecimento e habilidade dos profissionais para lidar com o assunto.Objective: to analyze the functional health literacy (FHL), i.e., understanding and knowledge about chronic renal disease of 60 patients in pre-dialytic treatment. Method: this is a cross-sectional study. FHL was measured by B-TOFHLA; and the knowledge, by questionnaire. Pearson correlation and Chi-square tests were carried out as well as linear regression models. Results: all respondents presented inadequate FHL, and most showed insufficient knowledge about the disease and treatment. Low schooling was a predictive factor for worst FHL scores. Insufficient knowledge was related to age and compromised cognition. Conclusion: although association between predictive variables has not been found, limited capability to obtain and use health-related information and insufficient knowledge about their own condition and treatment can contribute to worse outcomes for CKD. Appropriate intervention strategies are necessary to deal with limited FHL and also greater knowledge and ability of professionals to deal with the matter.

Functional health literacy and knowledge of renal patients on pre-dialytic treatment

Objetivo: analisar o letramento funcional em saude (LFS) e o conhecimento sobre doenca renal cronica de 60 pacientes em tratamento pre-dialitico. Metodo: estudo transversal. O LFS foi mensurado pelo instrumento B-TOFHLA; e o conhecimento, por questionario. Foram realizados testes de correlacao de Pearson e Qui-quadrado e modelos de regressoes lineares. Resultados: todos entrevistados apresentaram LFS inadequado, e a maioria apresentou conhecimento insuficiente em relacao a doenca e ao tratamento. Menor escolaridade foi fator preditivo para piores escores de LFS. Conhecimento insuficiente foi relacionado a idade e ao comprometimento cognitivo. Conclusao: embora nao tenha sido encontrada associacao entre as variaveis preditivas, a limitada capacidade de obter e usar informacoes relacionadas a saude e o conhecimento insuficiente em relacao a propria doenca e tratamento podem contribuir para piores desfechos de DRC. Sao necessarias estrategias de intervencoes adequadas ao limitado LFS e maior conhecimento e habilidade dos profissionais para lidar com o assunto.Objective: to analyze the functional health literacy (FHL), i.e., understanding and knowledge about chronic renal disease of 60 patients in pre-dialytic treatment. Method: this is a cross-sectional study. FHL was measured by B-TOFHLA; and the knowledge, by questionnaire. Pearson correlation and Chi-square tests were carried out as well as linear regression models. Results: all respondents presented inadequate FHL, and most showed insufficient knowledge about the disease and treatment. Low schooling was a predictive factor for worst FHL scores. Insufficient knowledge was related to age and compromised cognition. Conclusion: although association between predictive variables has not been found, limited capability to obtain and use health-related information and insufficient knowledge about their own condition and treatment can contribute to worse outcomes for CKD. Appropriate intervention strategies are necessary to deal with limited FHL and also greater knowledge and ability of professionals to deal with the matter.

Monitoring of post-vaccination anti-HBs titles vaccine in childrenand adolescents in the pre-dialysis of chronic kidney disease

INTRODUCTION Bacterial or viral diseases are one of the major causes of death in patients with chronic kidney disease (CKD). These patients show a quantitative reduction of levels of antibodies over time. Among the infectious diseases that affect CKD patients, stands out hepatitis B (HB). Immunization and control of antibodies levels against the hepatitis B surface antigen (anti-HBs) are ways to prevent the HB infection in this population. Patients with anti-HBs levels ≥10 IU/ml are considered adequate responders, whereas those with anti-HBs levels ≥ 100 IU/ml are considered excellent responders. OBJECTIVE To analyze the variation of the anti-HBs levels obtained after vaccination against HB in children and adolescents in the pre-dialysis stage of CKD. METHODS A retrospective cohort study on anti-HBs levels of children and adolescents in the pre-dialysis stage of CKD. Correlation between levels of anti-HBs titers and time since the vaccination were estimated. RESULTS From the total of 116 studied patients most of the studied patients were considered excellent responders, obtaining in the three anti-HBs titers percentages of 70.7%, 62.1% and 54.9% respectively. The anti-HBs titer levels showed a negative correlation with the time since vaccination (Kendall Tau-b = -0.16; p = 0.02). CONCLUSION The majority of the studied population was vaccinated by PNI and showed excellent anti-HBs titer levels, even experiencing a progressive reduced response over the time.