End-stage renal disease (ESRD) is treated mainly by hemodialysis, however, hemodialysis is associated with frequent complications, some of them involve the increased intracranial pressure. In this context, monitoring the intracranial pressure of these patients may lead to a better understanding of how intracranial pressure morphology varies with hemodialysis. This study aimed to follow-up patients with ESRD by monitoring intracranial pressure before and after hemodialysis sessions using a noninvasive method. We followed-up 42 patients with ESRD in hemodialysis, for six months. Noninvasive intracranial pressure monitoring data were obtained through analysis of intracranial pressure waveform morphology, this information was uploaded to Brain4care® cloud algorithm for analysis. The cloud automatically sends a report containing intracranial pressure parameters. In total, 4881 data points were collected during the six months of follow-up. The intracranial pressure parameters (time to peak and P2/P1 ratio) were significantly higher in predialysis when compared to postdialysis for the three weekly sessions and throughout the follow-up period (p<0.01) data showed general improvement in brain compliance after the hemodialysis session. Furthermore, intracranial pressure parameters were significantly higher in the first weekly hemodialysis session (p<0.05). In conclusion, there were significant differences between pre and postdialysis intracranial pressure in patients with ESRD on hemodialysis. Additionally, the pattern of the intracranial pressure alterations was consistent over time suggesting that hemodialysis can improve time to peak and P2/P1 ratio which may reflect in brain 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.

End-stage renal disease (ESRD) is treated mainly by hemodialysis, however, hemodialysis is associated with frequent complications, some of them involve the increased intracranial pressure. In this context, monitoring the intracranial pressure of these patients may lead to a better understanding of how intracranial pressure morphology varies with hemodialysis. This study aimed to follow-up patients with ESRD by monitoring intracranial pressure before and after hemodialysis sessions using a noninvasive method. We followed-up 42 patients with ESRD in hemodialysis, for six months. Noninvasive intracranial pressure monitoring data were obtained through analysis of intracranial pressure waveform morphology, this information was uploaded to Brain4care® cloud algorithm for analysis. The cloud automatically sends a report containing intracranial pressure parameters. In total, 4881 data points were collected during the six months of follow-up. The intracranial pressure parameters (time to peak and P2/P1 ratio) were significantly higher in predialysis when compared to postdialysis for the three weekly sessions and throughout the follow-up period ( p <0.01) data showed general improvement in brain compliance after the hemodialysis session. Furthermore, intracranial pressure parameters were significantly higher in the first weekly hemodialysis session ( p <0.05). In conclusion, there were significant differences between pre and postdialysis intracranial pressure in patients with ESRD on hemodialysis. Additionally, the pattern of the intracranial pressure alterations was consistent over time suggesting that hemodialysis can improve time to peak and P2/P1 ratio which may reflect in brain compliance.

Background Cardiovascular disease (CVD) is the leading cause of death in patients with end-stage renal disease (ESRD). Elevated serum concentrations of myeloperoxidase (MPO) are associated with an increased risk of developing CVD. The objective of this study was to evaluate serum MPO levels, as well as other laboratory parameters, in individuals with ESRD, with and without CVD, undergoing hemodialysis. Methods 80 volunteers were admitted, divided into the following groups: control group (CON): 20 individuals without chronic kidney disease (CKD); ESRD group: 45 individuals with CKD stage V and ESRD/CVD group: 15 individuals with CKD stage V and with CVD. The following biomarkers were evaluated: MPO, High sensitivity C-reactive protein (hs-CRP) and α1-acid glycoprotein, following the manufacturer's guidelines in the package inserts. The data were processed through the statistical software SPSS 20.0®. Results The level of MPO for the CON group was 84 ng/mL (73–87 ng/mL), for the ESRD group 77 ng/mL (11–89 ng/mL) and for the ESRD/CVD group 21 ng/mL (8–47 ng/mL), with a significant statistical difference of the ESRD/CVD group from the CON and ESRD groups (p<0.001). For the parameters hs-CRP and α1-acid glycoprotein a statistical difference between the ESRD and ESRD/CVD groups from the CON group (p<0.0001) was observed, but not between the ESRD and ESRD/CVD groups. Conclusion It is suggested that further studies should be performed to define the potential role of MPO as a cardiovascular risk marker for patients with ESRD on hemodialysis.

forma não invasiva, considerando que esta avaliação poderá contribuir na terapêutica de pacientes com DRC em HD.

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.

BACKGROUND: 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. OBJECTIVES: 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). DESIGN AND SETTING: Cross-sectional study conducted at a renal replacement therapy center in Brazil. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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