This analysis, using data from the Brazilian kidney transplant (KT) COVID‐19 study, seeks to develop a prediction score to assist in COVID‐19 risk stratification in KT recipients. In this study, 1379 patients (35 sites) were enrolled, and a machine learning approach was used to fit models in a derivation cohort. A reduced Elastic Net model was selected, and the accuracy to predict the 28‐day fatality after the COVID‐19 diagnosis, assessed by the area under the ROC curve (AUC‐ROC), was confirmed in a validation cohort. The better calibration values were used to build the applicable ImAgeS score. The 28‐day fatality rate was 17% ( n = 235), which was associated with increasing age, hypertension and cardiovascular disease, higher body mass index, dyspnea, and use of mycophenolate acid or azathioprine. Higher kidney graft function, longer time of symptoms until COVID‐19 diagnosis, presence of anosmia or coryza, and use of mTOR inhibitor were associated with reduced risk of death. The coefficients of the best model were used to build the predictive score, which achieved an AUC‐ROC of 0.767 (95% CI 0.698–0.834) in the validation cohort. In conclusion, the easily applicable predictive model could assist health care practitioners in identifying non‐hospitalized kidney transplant patients that may require more intensive monitoring. Trial registration: ClinicalTrials.gov NCT04494776.

Metodologia para implantação de um sistema de gestão da qualidade em um centro de diálise Methodology for implementation of quality care in a dialysis center ABSTRACTThis study describes the methodology used to implement quality care in a dialysis center in São Luís, MA. A questionnaire, based on current legislation that regulates nursing, medicine, pharmacy, nutrition, water treatment station, storage and supply room, and occupational health and safety services, was used to collect the data. Findings were used to develop an action plan to address no compliance with legislation and to propose preventive measures of non-compliance according to quality review committee guidelines. The experience of the implementation of this methodology led to the development of the discipline "Organization Service" to facilitate the identification and management of service processes, planning and procedures standardization, documentation and records control, and to motivate critical analysis of outcomes for improvements in the quality of care. Keywords: System of quality management; Dialysis service; Quality control RESUMOO estudo apresenta a metodologia utilizada para implantar um Sistema de Gestão da Qualidade em um Centro de Diálise em São Luís-MA. Houve aplicação de um questionário fundamentado na legislação vigente nos Serviços de Enfermagem, Médico, Farmácia, Nutrição, Estação de tratamento d'água, Almoxarifado, Higienização, Manutenção e Segurança do Trabalho, resultando em um diagnóstico situacional. A partir deste diagnóstico, foi geradoo um plano de ação para tratar as não-conformidades identificadas e propor iniciativas de ações preventivas seguindo as diretrizes constantes em documentos elaborados pelo Comitê da Qualidade. A experiência de implantar essa metodologia desenvolveu uma disciplina e organização no serviço que possibilitou a identificação e gerenciamento dos seus processos, planejamento e padronização de procedimentos, controle de documentos e registros, além incentivar a análise crítica dos resultados objetivando promover a melhoria de desempenho dos processos. Descritores: Sistema de gestão da qualidade; Serviço de diálise; Controle de qualidade RESUMENEn este artículo se presenta la metodología utilizada para implantar un Sistema de Gestión de la Calidad en un Centro de Diálisis en Sao Luis-MA. Hubo aplicación de un cuestionario fundamentado en la legislación vigente en los Servicios de Enfermería, Médico, Farmacia, Nutrición, Estación de tratamiento del agua, Depósito, Higienización, Manutención y Seguridad del Trabajo, dando como resultado un diagnóstico situacional. A partir de ese diagnóstico, fue generado un plan de acción para tratar las inconformidades identificadas y proponer iniciativas de acciones preventivas siguiendo las directivas constantes en los documentos elaborados por el Comité de la Calidad. La experiencia de implantar esa metodología permitió el desarrollo de disciplina y organización en el servicio que posibilitó la identificación y administración de sus procesos, planificación y pa...

Background. The Neutrophil-to-Lymphocyte Ratio (NLR) and the Platelet-to-Lymphocyte Ratio (PLR) are inflammatory biomarkers for several diseases, such as cancer and cardiovascular morbidities; however, there are currently few studies on kidney diseases. We aimed to evaluate nondialysis patients and determine the association of NLR and PLR with inflammation in these patients. Methods. A prospective cross-sectional study was conducted with 85 patients at different stages of chronic kidney disease (CKD), treated at the Kidney Disease Prevention Center of the University Hospital of the Federal University of Maranhão. This study included adult nondialysis patients diagnosed with CKD. The participants’ blood samples were collected for a high-sensitivity C-reactive protein (hs-CRP) test and blood count. They were divided into two groups according to the presence or absence of inflammation based on the hs-CRP value (<0.5 mg/dL). NLR and PLR were calculated based on the absolute number of neutrophils, lymphocytes, and platelets and were compared between them and with hs-CRP. Statistical analysis was performed using the Stata software, with the Shapiro–Wilk, Mann–Whitney, Spearman’s Correlation, and receiver operating characteristic curve tests. This study was approved by the local ethics committee. Results. The participants were categorized into two groups: with inflammation (n = 64) and without inflammation (n = 21). The mean age was 61.43 ± 14.63 y. The NLR and PLR values were significantly different between the groups with and without inflammation ( p = 0.045 and p = 0.004 , respectively). However, only PLR showed a significant positive correlation with hs-CRP ( p = 0.015 ). The best cutoff point for NLR to detect inflammation was 1.98, with 76.19% sensitivity and 48.44% specificity. For PLR, it was 116.07, with 85.71% sensitivity and 51.56% specificity. There was no significant difference between the area under the NLR and PLR curve (0.71 vs. 0.64; p = 0.186 ) for this population. Conclusions. This study showed that PLR was positively correlated with hs-CRP in nondialysis CKD patients and can be used to identify inflammation in this population.

Background: Excess body fat has been growing alarmingly among adolescents, especially in low income and middle income countries where access to health services is scarce. Currently, the main method for assessing overweight in adolescents is the body mass index, but its use is criticized for its low sensitivity and high specificity, which may lead to a late diagnosis of comorbidities associated with excess body fat, such as cardiovascular diseases. Thus, the aim of this study was to develop a computational model using linear regression to predict obesity in adolescents and compare it with commonly used anthropometric methods. To improve the performance of our model, we estimated the percentage of fat and then classified the nutritional status of these adolescents. Methods: The model was developed using easily measurable socio-demographic and clinical variables from a database of 772 adolescents of both genders, aged 10–19 years. The predictive performance was evaluated by the following metrics: accuracy, sensitivity, specificity, and area under ROC curve. The performance of the method was compared to the anthropometric parameters: body mass index and waist-to-height ratio. Results: Our model showed a high correlation (R = 0.80) with the body fat percentage value obtained through bioimpedance. In addition, regarding discrimination, our model obtained better results compared to BMI and WHtR: AUROC = 0.80, 0.64, and 0.55, respectively. It also presented a high sensitivity of 92% and low false negative rate (6%), while BMI and WHtR showed low sensitivity (27% and 9.9%) and a high false negative rate (65% and 53%), respectively. Conclusions: The computational model of this study obtained a better performance in the evaluation of excess body fat in adolescents, compared to the usual anthropometric indicators presenting itself as a low cost alternative for screening obesity in adolescents living in Brazilian regions where financial resources are scarce.

Objectives: Sleep disorders in patients on hemodialysis are frequent, but few studies correlate these disorders with autonomic dysfunction in these patients. This study aimed to verify whether clinical and laboratory variables and heart rate variability are associated with worse sleep quality verified by the Pittsburg subjective scale in patients on hemodialysis. Material and Methods: A cross-sectional study was performed on forty-eight patients. Epidemiological, clinical, and laboratory data were collected. After were performed by recording the heart rate variability and applied Pittsburg questionnaires, Beck anxiety index (BAI), and Beck depression index (BDI). The global PSQI score >5 indicates that a person is a poor sleeper, the patients were divided according to the scores in the Pittsburg questionnaire into good and poor sleepers and the differences between all variables were analyzed. Results: Forty-eight patients were evaluated and the prevalence of 68.7% (n=33) of poor sleep quality was verified. From the depression and anxiety questionnaires, it was found that only 18.7% (n=9) had criteria for depression. In the analysis of the sympathetic dysfunction parameters, it was found that in the group with good sleep quality in the frequency domain (HFm 2 ) and the LFnu in the group with worse sleep quality. There was a positive correlation between sleep quality scores the anxiety and depression scores. It is also verified that the variables LFnu had a positive correlation with higher scores of quality of sleep and HFnu had a negative correlation with the highest scores of quality of sleep. Conclusion: In patients undergoing hemodialysis, the poorest quality of sleep is correlated with worse cardiac autonomic modulation as well as higher scores on the depression and anxiety scales.

Background: Disorders of mineral metabolism occur in most patients with chronic kidney disease (CKD). The aim of this work was to correlate serum parathyroid hormone (PTH) levels with urinary magnesium excretion in patients with non-dialysis CKD. Methods: Cross-sectional study with patients with CKD undergoing non-dialysis treatment in stages 3A, 3B and 4. Concentrations of creatinine, magnesium, calcium, phosphorus, parathyroid hormone, vitamin D and alkaline phosphatase were determined in blood samples. The assessment of urinary magnesium levels was performed by means of total daily excretion and by the excretion fraction (FEMg). Results: The study evaluated 163 patients with mean age of 60.7 ± 11.7 and 51.0% were male. A positive correlation was observed between PTH and alkaline phosphatase (r = 0.26; p = 0.006) and FEMg (r = 0.17; p = 0.020). Calcium (r = -0.23; p = 0.002), magnesium in 24-hour urine (r = -0.18; p = 0.020) and estimated glomerular filtration rate (r = -0.47; p = 0.001) demonstrated negative correlation with PTH. Conclusion: Elevated levels of PTH correlated positively with FEMg, regardless of the presence of serum magnesium alterations, and FEMg can be used as another indicator for the treatment of hyperparathyroidism.

Background: Disorders of mineral metabolism occur in most patients with chronic kidney disease (CKD). The aim of this work was to correlate serum parathyroid hormone (PTH) levels with urinary magnesium excretion in patients with non-dialysis CKD.Methods: Cross-sectional study with patients with CKD undergoing non-dialysis treatment in stages 3A, 3B and 4. Concentrations of creatinine, magnesium, calcium, phosphorus, parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D] and alkaline phosphatase (ALP) were determined in blood samples. The assessment of urinary magnesium levels was performed by means of total daily excretion and by the excretion fraction (FEMg). Results: The study evaluated 163 patients with a mean age of 60.7 ± 11.7 years and 51.0% were male. In the highest quartile of PTH (> 89.5pg / ml), the mean levels of FEMg and ALP were higher (p <0.05), as well as the levels of serum calcium and eGFR were lower (p <0.05). In the unadjusted regression analysis, the following variables were related to serum PTH levels: FEMg (odds ratio (OR) = 1.12; 95% confidence intervals (CI): 1.02–1.23), Calcium (OR = 0.45; 95% CI: 0.22-0.90), ALP (OR = 1.02; 95% CI: 1.00-1.03) and eTFG (OR = 0.92; 95% CI: 1.00-1.03). After an adjusted analysis, only one FEMg and ALP will remain correlated with PTH. Conclusion: In patients with non-dialysis CKD, with higher levels of PTH, higher mean columns of ALP and FEMg, and lower levels of serum calcium and eGFR. FEMg and ALP were some variables that remained associated with PTH.

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