Despite advancements in renal replacement therapies and increased survival, patients still face several physical, psychological and social limitations as consequences of chronic kidney disease and treatment complexity. 1,2 The daily struggle with end-stage renal disease symptoms and related comorbidities, along with the need to cope with psychosocial stressors, directly impacts patients' quality of life and mental health. 3,4 Depression and anxiety are considered to be the most common end-stage renal disease-related psychological disorders, with higher prevalence and incidence rates in this population than those in the general population. 5-10 According to the World Health Organization, the estimated global prevalence rates of depression and anxiety in 2015 were 4.4% and 3.6%, respectively, with an increase in reported cases of 18% between 2005 and 2015. 11 The anxiety and depression rates that have been estimated among end-stage renal disease patients are not accurate: they range from 0 to 100%, depending on the diagnostic criteria, assessment tool and population characteristics. 12 A systematic review of 55 studies revealed prevalence rates of 38% and 27% for anxiety and depression, respectively, among end-stage renal disease patients. 13 The high frequency and impact of affective symptoms in nephrology practice have led the research community to devote increasing attention to depression and anxiety over the last few years. 7 In end-stage renal disease, these mental disorders are associated with various conditions that lead to poorer health outcomes, with direct impacts on patients' quality of life and survival. 14-23 Anxiety and depression are also associated with unhealthy forms of behavior, such as alcohol and tobacco use, poor eating habits, sedentary lifestyle and non-compliance with treatment. 24 These factors translate into increased risks of clinical events and the need for emergency services, thus resulting in higher healthcare costs. 25-26

Background and objectivesSecondary hyperparathyroidism (SHPT) in CKD is associated with an increased risk for mortality, but definitive data showing that parathormone control decreases mortality is still lacking. This study aimed to compare the mortality of patients with severe SHPT submitted to parathyroidectomy(PTX) with those who did not have access to surgery.MethodsThis is a retrospective study in a cohort of 251 CKD patients with severe SHPT who were referred to a CKD-MBD Center for PTX from 2005 until 2012.ResultsMost of our patients had indication of PTX, but only 49% of them had access to this surgical procedure. After a mean follow-up of 23 months, 72 patients had died. Non-survivors were older; more often had diabetes, lower serum 25 vitamin D and mostly had not been submitted to surgery. The relative risk of death was lower in the PTX patients (0.428; 95% CI, 0.28 to 0.67; p<0.0001). After adjustments, mortality risk was dependent on age (1.04; 95% CI, 1.01 to 1.07; p = 0.002), 25 vitamin D (0.43; 95% CI, 0.24 to 0.81; p = 0.006) and no access to PTX (4.13; 95% CI, 2.16 to 7.88; p<0.0001). Results remained the same in a second model using the PTX date as the study start date for the PTX group.ConclusionsOur data confirms the benefit of PTX on mortality in patients with severe SHPT. The high mortality encountered in our population is significant and urges the need to better treat these patients.

The majority of severe hypersensitivity reactions in hemodialysis patients have occurred due to sensitization to ethylene oxide or to nonbiocompatible membrane dialyzers. The use of polysulfone dialyzers rarely causes hypersensitivity reactions. In the present study, we describe a case of severe life-threatening reactions induced by polysulfone dialyzers (from different manufacturers subjected to a variety of sterilization methods), which occurred after 9 sessions of hemodialysis with the same prescription, exemplifying the complexity of such reactions.

We produced this document to bring pertinent information to the practice of nephrology, as regards to the renal involvement with COVID-19, the management of acute kidney injury cases, and practical guidance on the provision of dialysis support.As information on COVID-19 evolves at a pace never before seen in medical science, these recommendations, although based on recent scientific evidence, refer to the present moment. The guidelines may be updated when published data and other relevant information become available.

Contrast-induced nephropathy is a common form of hospital-acquired acute kidney injury. Incidence is low in patients with normal renal function but increases in high-risk patients. Patients with contrast-induced nephropathy have higher in-hospital complication rates and mortality. Critically ill patients have been assumed to be a high-risk group for contrast-induced nephropathy. In the previous issue of Critical Care, Cely and colleagues showed an unexpectedly low incidence of contrast-induced nephropathy in critically ill patients receiving radiographic contrast material for computerized tomography. We should note that it is difficult to establish the true frequency and impact of the contrast nephrotoxicity because of many other causes for acute kidney injury in this population. Moreover, the impact on long-term kidney function and the possible effect of this insult on the recovery of renal function when associated with other causes of acute kidney injury are unknown.

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Cerebrovascular accident is the pathology with the greatest development of clinical signs and focal and/or global disturbances in brain function, with various symptoms lasting 24 hours and resulting from vascular origin. Bringing sequelae to the patient, functional, sensitive, emotional and mental. And to alleviate this damage, it is necessary for the patient to have access to all treatments aimed at their needs, observing their capabilities and potential. Physiotherapy used techniques with the aim of stimulating CNS connections, with the intention of promoting sensorial stimuli for the recovery of functional movements, and in the prevention of deformities and complications, bringing independence and better quality of life. Treatment with equine therapy will bring results in tonic adjustments, improvement in posture, balance, stimulation of tactile and visual sensibilities, body awareness and increased self-esteem, in this therapeutic method of rules and disciplines it increases the capacity for decisions and independence in different situations.

A Deus, pela vida, coragem e força. À Prof. Etienne, um exemplo de ética e competência como professora, pesquisadora e profissional. Contribuiu imensamente para meu crescimento científico e intelectual. Obrigada pela atenção e pelo apoio durante o processo do Doutorado. Ao CNPq, pela concessão da bolsa de Doutorado e pelo apoio financeiro para a realização desta pesquisa. Ao Dr. Rui Toledo, pelo estímulo em ingressar no Doturado, ao Prof. Burdmann e aos funcionários da pós-graduação da Nefrologia da FMUSP.