Revista de la Sociedad Ecuatoriana de Nefrología, Diálisis y Trasplante
REV SEN is the biannual publication of the Ecuadorian Society of Nephrology, Dialysis, and Transplantation. The aim of the publication is to the field related to nephrology, its procedures, replacement treatments for kidney function, and kidney transplantation. REV SEN is published semi-annually and is reviewed by blinded peers.
Sociedad Ecuatoriana de Nefrología, Diálisis y Trasplante
Is it really well-positioned? Computed tomography vs. chest X-ray in the evaluation of hemodialysis catheters.
Introduction: Proper positioning of the central venous catheter tip for hemodialysis is crucial to ensure efficient flow and reduce complications such as access dysfunction, thrombosis, arrhythmias, and vascular perforation. Chest radiography is the most commonly used method for post-procedure verification; however, computed tomography (CT) offers greater anatomical precision and is considered the gold standard for evaluating catheter tip location. Materials and Methods: We conducted a retrospective analytical study using a database (n=185) of patients diagnosed with stage G5 chronic kidney disease (CKD) undergoing hemodialysis between January 2025 and June 2026. Patients were categorized into three groups: G1: Central stenosis (n=116/67%); G2: Vascular access exhaustion (n=56/30.2%); and G3: Catheter dysfunction (n=13/7%). Group 3 underwent CT scanning to compare the results with the conventional follow-up chest X-ray routinely performed after device placement. Images were analyzed in collaboration with a radiologist to determine the catheter tip location. This analysis focuses on Group 3. Results: Patient ages ranged from 30 to 83 years (mean: 62.6). Twelve catheters were tunneled and one was temporary; nine were inserted via the jugular vein and four via the femoral vein. In six cases, the tip was located outside the atrium; two were positioned over common iliac artery stenoses; one was in the left common iliac vein, compressed by the overlying common iliac artery (May-Thurner syndrome); two showed kinking (one along the catheter tract and one at the tip); one was located in the external iliac vein; and in one case, the cause of dysfunction was not identified. Three patients underwent catheter repositioning, involving the withdrawal of approximately 3 cm of the catheter. One patient underwent no procedure, and eight received a new catheter placed under fluoroscopic guidance with angiographic monitoring. Conclusion: Computed tomography is more accurate than chest radiography for determining the position of hemodialysis catheter tips and serves as the reference method in validation studies. However, its use should be reserved for complex cases or suspected malposition.
Favio Arturo Carrera Maigua, Andrea Carolina Buenaño Núñez.
Copyright (c) 2026 Favio Arturo Carrera Maigua, Andrea Carolina Buenaño Núñez. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Diffuse atherosclerotic disease: a challenge in the management of renovascular hypertension.
Introduction: Chronic non-communicable diseases are the leading cause of morbidity in Ecuador; 20% of adults suffer from arterial hypertension. In older adults, atherosclerotic renovascular disease accounts for up to 35% of cases of secondary hypertension, thereby increasing cardiovascular risk. Case Report: An 82-year-old male with a history of arterial hypertension since age 77 (treated with valsartan/amlodipine) presented with weakness in the right lower limb that had persisted for 45 days. Upon admission, his blood pressure was 160/98 mmHg. Brain MRI revealed subacute ischemic lesions and evidence of prior hemorrhages. CT angiography showed a "shaggy aorta" and severe stenosis (involving the right internal carotid and renal arteries) (Figure 1, Table 1); laboratory findings included creatinine 1.85 mg/dL, eGFR 35 mL/min/1.73 m², and ACR 445.4 mg/g, consistent with chronic kidney disease secondary to hypertensive nephroangiosclerosis. Due to deteriorating renal function (creatinine 2.3 mg/dL; eGFR 27 mL/min/1.73 m²), the ARB was discontinued and treatment with calcium channel blockers and beta-blockers was initiated, resulting in partial recovery of renal function (creatinine 1.6; eGFR 42). Revascularization was ruled out due to high embolic risk, and medical management was prescribed. Two months later, the patient was readmitted with a thrombogenic spinal cord infarction (C7-T1), arterial hypertension, and a need for antithrombotic treatment adjustment. Results: Renal artery stenosis >50% causes hemodynamic impact, while stenosis >70% leads to renovascular hypertension. A "shaggy aorta" is associated with a high risk of systemic embolization, and medical management offers greater benefit than interventional procedures. The use of ACE inhibitors or ARBs in the presence of bilateral renal artery stenosis promotes the deterioration of renal function. Conclusion: Diffuse aortic atheromatosis increases morbidity and mortality 4.1-fold and predisposes patients to thromboembolic events. Endarterectomy is not recommended due to the high risk of stroke; individualized medical management is the best alternative, especially when renovascular hypertension coexists.
Kateherine Fonte Melendres, Fernando Jiménez Jaramillo.
Copyright (c) 2026 Kateherine Fonte Melendres, Fernando Jiménez Jaramillo. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Serum albumin and risk of peritonitis in peritoneal dialysis patients: experience of a renal program.
Introduction: Peritonitis associated with peritoneal dialysis remains a major infectious complication. It is linked to hospitalization, technique failure, catheter removal, transfer to hemodialysis, and increased morbidity. Serum albumin is a widely available biomarker that reflects not only nutritional status but also inflammation, clinical frailty, and immunological vulnerability. Therefore, assessing it could be useful for stratifying the risk of peritonitis in patients undergoing peritoneal dialysis. According to the 2022 International Society for Peritoneal Dialysis (ISPD) guidelines, preventing peritonitis requires a multifactorial approach that includes the continuous assessment of the patient's nutritional and inflammatory status (1). Serum albumin is a widely available, low-cost biomarker reflecting not only nutritional status but also the presence of systemic inflammation, clinical frailty, and immunological vulnerability. Recent studies suggest that hypoalbuminemia (<3.5 g/dL) is associated with impaired peritoneal membrane function and a compromised local immune response, thereby increasing susceptibility to infections (2), (3). The aim of this study was to evaluate the association between serum albumin levels and the risk of developing peritonitis in a cohort of peritoneal dialysis patients, using survival analysis to stratify clinical risk. Materials and methods: An observational, analytical, retrospective study was conducted on adult patients undergoing peritoneal dialysis (PD) who had remained on the modality for more than three months and had available serum albumin records. Patients with incomplete follow-up or those who switched to hemodialysis before the three-month mark were excluded. Demographic variables (age, sex), clinical variables (diagnosis of end-stage renal disease, comorbidities, duration of PD), and laboratory variables (mean serum albumin, hemoglobin, potassium) were collected. The primary outcome was the occurrence of at least one episode of peritonitis, defined according to ISPD criteria (cloudy effluent, leukocyte count >100/µL with >50% polymorphonuclear cells, and/or positive culture) (1). Patients were classified into two groups based on mean serum albumin levels: <3.5 g/dL (hypoalbuminemia) and ≥3.5 g/dL. Continuous variables were expressed as mean ± standard deviation, and categorical variables as frequencies. Fisher's exact test was used to compare proportions. Peritonitis-free survival was estimated using the Kaplan-Meier method, and curves were compared using the log-rank test. A Cox proportional hazards model was fitted to calculate the hazard ratio (HR) for peritonitis associated with hypoalbuminemia, adjusting for age and duration of PD. A p-value < 0.05 was considered statistically significant. The analysis was performed using Python. Results: Thirty-one adult patients enrolled in the peritoneal dialysis program were included and followed for 12 months. The mean age was 47.4 ± 17.3 years, and the mean duration of peritoneal dialysis was 9.8 ± 9.1 months. When patients were stratified by their average serum albumin level, 5 patients (16.1%) presented with hypoalbuminemia (<3.5 g/dL), while 26 patients (83.9%) maintained levels ≥3.5 g/dL. Regarding the incidence of peritonitis, it was observed that 18 of the 31 patients (58.1%) experienced at least one episode during the follow-up period. Furthermore, a marked difference in incidence was observed: 100% (5/5) of patients with hypoalbuminemia developed peritonitis, compared to 50% (13/26) of patients with albumin levels ≥3.5 g/dL. This finding corresponds to a relative risk (RR) of 2.00 (95% CI: 1.36–2.94; p=0.058, Fisher's exact test). Kaplan-Meier survival analysis demonstrated that the median peritonitis-free time was significantly shorter in the hypoalbuminemia group (6 months) than in the reference group (11 months; log-rank test: p=0.0096). Finally, the Cox proportional hazards model (Table 2) confirmed that hypoalbuminemia is a robust, independent predictor of peritonitis. After adjusting for age and time on dialysis, patients with albumin levels <3.5 g/dL showed a Hazard Ratio (HR) of 9.68 (95% CI: 2.70–34.65; p<0.001), indicating a nearly 10-fold higher risk of developing a first infectious episode, regardless of other clinical variables. The finding that the Cox model yields an HR of 9.68 (p=0.011) is remarkable; in a cohort of 31 patients, this value indicates that those with hypoalbuminemia are at nearly 10 times the risk of developing a first episode of peritonitis compared to those with normal albumin levels, irrespective of age or duration of dialysis. Conclusions: Serum albumin <3.5 g/dL is an independent, high-risk predictor for the development of peritonitis in patients undergoing peritoneal dialysis (PD), whereas other variables—such as age and duration of PD treatment—are significant predictors (p > 0.05), confirming that hypoalbuminemia is the true independent driver of infection risk. Routine monitoring of this parameter enables the early identification of the most vulnerable patients and facilitates the implementation of targeted, personalized preventive interventions in strict compliance with ISPD quality standards. Prospective studies with larger cohorts are recommended to validate these findings and establish early nutritional and immunological intervention protocols.
Dayana de Jesús Olmos Suarez, Melba Cecilia Giraldo Loor, Gabriel Antonio Macías Farías.
Copyright (c) 2026 Dayana de Jesús Olmos Suarez, Melba Cecilia Giraldo Loor, Gabriel Antonio Macías Farías. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Older adult with refractory hypertension.
Introduction: Primary hyperaldosteronism is a common cause of secondary hypertension associated with target-organ damage (myocardial fibrosis, arterial stiffness, and albuminuria) resulting from direct effects on the mineralocorticoid receptor—beyond hemodynamic impacts on blood pressure. Although it is a potentially curable, independent cardiovascular risk factor, it remains underdiagnosed; furthermore, in the elderly, patients are rarely considered candidates for definitive evaluation or treatment. Case Report: An 89-year-old male with a history of COPD, former smoking, and hypothyroidism presented with difficult-to-control hypertension since age 57, refractory to multiple regimens and requiring six antihypertensive agents at optimal doses (ARBs, alpha-blockers, calcium channel blockers, and diuretics). He was referred to nephrology due to persistent proteinuria (albumin-to-creatinine ratio [ACR]: 545 mg/g); baseline echocardiography showed a global strain of -10%, grade II diastolic dysfunction, and elevated filling pressures. Incidental findings during hospitalization for pneumonia included hypokalemia and an elevated transtubular potassium gradient; aldosterone-to-active renin ratio results were inconclusive due to medication interference. Imaging revealed a left renal tumor (40 mm) and a right adrenal nodule (9 mm); empiric spironolactone therapy and potassium replacement were initiated. Biochemical, imaging, and clinical findings were consistent with a unilateral aldosterone-producing adenoma; adrenalectomy was performed. Results: The 5-year risk of renal failure decreased from 2.10% to 0.83%, ACR dropped from 545 to 34.3 mg/g, the antihypertensive regimen was reduced from six to two drugs, and blood pressure levels decreased. Conclusions: Confirmatory testing should not delay the initiation of treatment when significant, concordant findings are present. Suspending pharmacological treatment for 4 to 6 weeks improves the accuracy of hormonal sampling. The objectives include: reducing risks associated with target-organ damage; obtaining data that can be extrapolated and potentially applied to the heart; reducing hypertrophy, filling pressures, and longitudinal strain; halting progression toward renal failure; and improving quality of life. Age is not a reason to delay surgical treatment.
Copyright (c) 2026 Fernando Jiménez, J Chamorro. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
PLA2R-positive membranous nephropathy treated with rituximab (MENTOR regimen) in a patient with concomitant endometrial carcinoma
Introduction: Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in adults. The M-type phospholipase A2 receptor (PLA2R) is the podocyte antigen responsible for the majority of primary cases, and its detection has revolutionized the diagnosis and monitoring of the disease. Treatment with rituximab, particularly using regimens such as that of the MENTOR study, has demonstrated sustained long-term efficacy. We present a case of PLA2R-positive MN with a good response to rituximab, complicated by the incidental finding of endometrial carcinoma during follow-up. Case report: A 44-year-old female patient with no significant medical history presented with progressive lower-extremity edema of four months' duration. Results: The patient exhibited persistent dyslipidemia and nephrotic-range proteinuria (2813 mg/24h), with preserved renal function (creatinine 0.5 mg/dl) and negative autoimmune serology. Renal biopsy confirmed MN with PLA2R positivity—a result corroborated by positive serum anti-PLA2R antibodies (25.2 IU/ml)—with no associated chronic lesions. Treatment was initiated with methylprednisolone pulse therapy followed by oral prednisone, and subsequently rituximab using the MENTOR regimen (two 1 g doses spaced 15 days apart), resulting in a good clinical response: progressive reduction of edema and foamy urine. Following the second dose, she experienced amenorrhea followed by abnormal uterine bleeding; endometrial biopsy revealed grade I endometrial carcinoma (node-negative), which was treated via radical hysterectomy without the need for adjuvant therapy. Conclusions: This case confirms the efficacy of the MENTOR rituximab regimen in inducing clinical remission in PLA2R-positive MN, consistent with published evidence reporting remission rates exceeding 60% at 24 months. Likewise, it highlights the importance of active gynecological surveillance during immunosuppressive treatment, given the incidental finding of an early-stage endometrial neoplasm with an excellent prognosis following timely management.
Stephanny Michele Cuenca Hidalgo, Fernando Stalin Jiménez Jaramillo.
Copyright (c) 2026 Stephanny Michele Cuenca Hidalgo, Fernando Stalin Jiménez Jaramillo. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Anchoring bias in a kidney transplant recipient with persistent fever and urinary symptoms
Introduction: Infections are a leading cause of morbidity and mortality among kidney transplant recipients. In endemic areas, tuberculosis can present with atypical extrapulmonary manifestations that mimic common bacterial infections, potentially leading to diagnostic delays. We present a case illustrating how anchoring bias—stemming from a urinary tract infection—hindered the timely recognition of disseminated tuberculosis. Case report: We report the case of a 64-year-old man who underwent deceased-donor kidney transplantation for chronic kidney disease secondary to diabetes mellitus and arterial hypertension. Pre-transplant protocols, including infection screening, yielded negative results. A retrospective review was conducted of his medical history, hospital course, microbiological studies, imaging, and pathological findings. Results: During post-transplant follow-up, the patient experienced delayed graft function, a lymphocele, and choledocholithiasis. He required multiple hospitalizations for fever and lower urinary tract symptoms, which were treated as urinary tract infections with various antibiotic regimens despite repeatedly negative urine cultures. Persistent urinary frequency, urgency, and dysuria, followed by rectal tenesmus, led to the decision to perform a prostatectomy, during which a prostatic abscess was identified. Subsequently, the patient developed neurological deterioration and seizures. Polymerase chain reaction (PCR) testing for *Mycobacterium tuberculosis* in the cerebrospinal fluid confirmed disseminated central nervous system tuberculosis. A prostate biopsy confirmed the diagnosis of tuberculosis. Treatment with an RIPE regimen and corticosteroids was initiated, requiring close monitoring of immunosuppressive therapy due to drug-drug interactions. Conclusions: In kidney transplant recipients, persistent fever and urinary symptoms in the absence of microbiological confirmation should prompt a diagnostic re-evaluation. In endemic regions, extrapulmonary tuberculosis should be considered early to avoid anchoring bias toward urinary tract infection and to reduce delays in diagnosis and treatment.
Diana Moreira Vera, Fernando Stalin Jiménez Jaramillo.
Copyright (c) 2026 Diana Moreira Vera, Fernando Stalin Jiménez Jaramillo. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Retrospective observational study of percutaneous peritoneal dialysis catheter placement using the Veress needle versus the conventional percutaneous technique.
Introduction: Percutaneous placement of a peritoneal dialysis catheter is a minimally invasive alternative for peritoneal access. Initial entry into the peritoneal cavity is the highest-risk step due to the potential for injury to intra-abdominal organs. To improve procedure safety, a modified technique using a Veress needle for initial access was implemented. The study aimed to compare the feasibility, technical success, and complication rates of percutaneous peritoneal dialysis catheter placement using the Veress needle technique versus the conventional percutaneous technique. Materials and methods: A retrospective observational study was conducted involving 15 patients undergoing percutaneous peritoneal dialysis catheter placement: the Veress needle technique (n=7) and the conventional technique (n=8). Baseline characteristics, procedural success, and complications were compared using the Mann-Whitney U test and Fisher's exact test, with statistical significance set at p < 0.05. Results: The groups were comparable regarding age, body mass index, sex, and comorbidities. No significant differences were observed regarding immediate functional success, correct catheter positioning, or bleeding. No instances of peritoneal leakage or bowel perforation were recorded. The Veress needle technique was associated with lower rates of catheter dysfunction at 30 days (14.3% vs. 75.0%; p = 0.041) and a reduced need for surgical repositioning (14.3% vs. 75.0%; p = 0.041). Conclusions: The percutaneous Veress needle technique proved feasible and safe, associating with lower rates of catheter dysfunction and surgical repositioning at 30 days without increasing complications. Prospective studies with larger sample sizes are needed to confirm these findings.
Percutaneous peritoneal dialysis catheter placement
Adela Anguisaca Vega, Cristina Chediak Terán, Darwin Larcos, Meri Orna, Mayra Oñate, Belén Larco.
Copyright (c) 2026 Adela Anguisaca Vega, Cristina Chediak Terán, Darwin Larcos, Meri Orna, Mayra Oñate, Belén Larco. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Phase angle and body composition as determinants of functional capacity in hemodialysis.
Introduction: Hemodialysis (HD) induces severe stress that alters patients' nutritional status and physical autonomy. Phase angle (PA) and the Barthel Index (BI) allow for a comprehensive assessment of this impact. The aim of this study was to determine the association between PA, body composition, and functional capacity, and to identify specific phenotypic profiles using K-means clustering. Materials and Methods: A retrospective, observational study (February 2021 – October 2022) involving 127 HD patients. PA, fat mass (FAT), lean tissue mass (LTM), and body cell mass (BCM) were measured using pre-dialysis multifrequency bioelectrical impedance analysis (BIA), while functionality was assessed using the BI. Pearson correlation and K-means clustering (k=3) analyses were applied, supported by principal component analysis (PCA). Results: PA correlated positively with BI (r = 0.39, p < 0.001) and BCM (r = 0.61, p < 0.001), and negatively with FAT (r = -0.35, p = 0.002). The K-means model identified three distinct profiles: Cluster 0 (High Risk): Older patients (65.9 ± 10.2 years) with low PA (3.57 ± 0.6°), higher adiposity (42.25 ± 8.4%), lower LTM (37.11 ± 6.9 kg), and lower functionality (BI: 75.45 ± 12.8). Cluster 1 (Preserved): individuals with high PA (5.5 ± 0.7°), low FAT (25.54 ± 6.2%), high LTM (62.18 ± 8.7 kg), and functional independence (BI: 94.17 ± 6.9). Cluster 2 (Intermediate): Lower mean age (48.35 ± 11.4 years), mixed composition (FAT: 36.57%, LTM: 47.91 kg), moderate PA (4.69 ± 0.8°), and high functionality (BI: 97.38 ± 2.6). Conclusions: PA and body composition are significantly associated with functionality. Automated cluster-based segmentation optimizes the identification of subgroups at functional and nutritional risk, enabling the guidance of personalized dietary interventions to preserve quality of life.
Copyright (c) 2026 Kevin Gabriel Armijo Valverde (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Bilateral Wilms' tumor in childhood: a case report.
Introduction: Wilms tumor, also known as nephroblastoma, is the second most common intra-abdominal cancer in childhood and the fifth most frequent pediatric malignancy; it accounts for 6% of all pediatric cancers and is the most common renal tumor (comprising over 95% of all pediatric renal tumors). It typically presents between the ages of 2 and 5, with 95% of cases diagnosed before age 10. The initial presentation is usually an abdominal mass—often detected at an advanced stage of the disease—accompanied by intermittent hematuria. Bilateral renal tumors are very rare in the pediatric population. Diagnosis is achieved via ultrasound, abdominal CT, or MRI; while the diagnosis is based on clinical and imaging findings, definitive diagnosis is histopathological. Case Report: This case involves a newborn with bilateral Wilms tumor (nephroblastoma), an uncommon presentation among pediatric renal neoplasms. Following physical examination and complementary clinical and imaging studies, a treatment plan focused on nephron-sparing surgery was established. Through a therapeutic intervention combining nephrectomy and nephron-sparing surgery, adequate renal function was maintained in the patient. Conclusion: Bilateral Wilms tumor represents an atypical and complex presentation requiring a specialized multidisciplinary approach (such as the SIOP UMBRELLA 2016 protocol, chemotherapy, conservative surgical techniques or nephrectomy, and potentially radiotherapy). Implementing nephron-sparing surgery in these cases is crucial for preserving long-term renal function, with histopathological analysis, staging, and comprehensive follow-up during the first year serving as key factors in determining the patient's prognosis.
Copyright (c) 2026 Gabriela E, Adriana C, Junior Gaona. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Digital monitoring in peritoneal dialysis: remote monitoring and risk stratification as a scalable model of care at the national level.
Introduction: Peritoneal dialysis (PD) requires adherence to technique and continuous monitoring to prevent complications. Digital technologies enable expanded monitoring and optimized care. The objective was to describe the implementation of a nurse-led remote monitoring program and the results of a digital risk calculator for PD patients. Materials and Methods: A prospective, descriptive, observational study was conducted between February and June 2026 within the PD program at the Calderón General Teaching Hospital. Zoom video calls were used to assess clinical status, dialysis technique, medication adherence, and the home environment. A digital calculator was developed using 24 variables grouped into five areas: clinical manifestations, dialysis technique, medication adherence, home environment, and mechanical failures. Patients were stratified into low (0–3), intermediate (4–7), and high (≥8 points) risk categories. Results: Remote monitoring was performed on 20 patients (mean age 42.9 ± 12.9 years; 60% female; mean time on PD 24.2 ± 23.0 months). The calculator classified 12 patients (60%) as low risk and 8 (40%) as intermediate risk; no patients were classified as high risk. Situations requiring intervention were identified in the majority of patients during remote monitoring. The most frequent findings were errors in dialysis technique (11; 55%), clinical manifestations (10; 50%), and issues regarding medication adherence or recent hospitalization (8; 40%), followed by inadequate environmental conditions (3; 15%) and mechanical failures (1; 5%). Educational interventions and early re-evaluation were carried out for 8 patients (40%) without requiring an in-person visit, and the issues were resolved in a timely manner. Conclusions: Remote monitoring enabled the identification of modifiable situations, and the digital calculator facilitated risk stratification and the definition of individualized interventions, demonstrating the feasibility of strengthening PD surveillance and promoting scalable digital models at the national level.
Cristina Chediak, Mercy Yerovi, Belén Larco, Elsy Escudero, Patricia Chipantaxi, Adela Angüisaca, Ángel Santillán.
Copyright (c) 2026 Cristina Chediak, Mercy Yerovi, Belén Larco, Elsy Escudero, Patricia Chipantaxi, Adela Angüisaca, Ángel Santillán. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Hemoadsorption for acute pesticide and drug poisoning in Ecuador: a multicenter retrospective observational study of local experience over 13 years.
Introduction: Pesticides and other drugs frequently cause acute poisoning (AP) in Ecuador. Reported mortality is high. Hemoadsorption (HA) offers a therapeutic option for removing certain toxins, yet its use remains limited. Objective: To evaluate clinical outcomes in patients with AP treated with HA and to identify factors associated with mortality. Materials and Methods: A multicenter, retrospective, observational-analytical study was conducted on critically ill adult patients with AP treated with HA—either alone or combined with intermittent hemodialysis—across 11 ICUs in Ecuador (January 2013–February 2026). Clinical characteristics, type of toxin, organ support, and in-hospital mortality were analyzed. Additionally, an exploratory multivariable logistic regression was performed. Results: The study included 135 critically ill patients with AP treated with HA. The median age was 24.5 years, and 57.8% were female. Organophosphate poisoning was the most frequent exposure (25.9%), followed by carbamazepine (16.3%) and paraquat (8.9%). Mechanical ventilation was required in 52.6% of cases, and vasoactive agents in 32.6%. The median ICU stay was 3 days, and in-hospital mortality was 5.2%. Non-survivors were older and presented with higher SOFA scores, longer durations of mechanical ventilation, and a greater number of hemoadsorption sessions. In the multivariable analysis, paraquat showed a significant association with in-hospital mortality (adjusted OR: 6.36; 95% CI: 1.13–35.86; p = 0.036), while the SOFA score showed a non-significant trend. Conclusions: HA is a feasible strategy for critically ill patients with AP. Mortality was low and showed a statistically significant association with the type of toxic agent (paraquat), the SOFA score, the duration of mechanical ventilation, and the number of sessions required. No difference was observed regarding the time elapsed between toxic ingestion and the initiation of therapy, supporting a recommendation for earlier treatment initiation in all types of poisoning. Prospective, controlled studies are needed to define efficacy, the optimal timing of administration, and patient selection criteria.
Joseph Paredes, Jazmín Jiménez, Andrés Herdoiza, Darío Jiménez.
Copyright (c) 2026 Joseph Paredes, Jazmín Jiménez, Andrés Herdoiza, Darío Jiménez. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Association of hypokalemia with cardiovascular mortality and residual diuresis in patients on thrice-weekly hemodialysis.
Introduction: Potassium metabolism disorders are common in dialysis patients and are associated with an increased risk of arrhythmias and cardiovascular mortality. Dialysate potassium concentration, the correction of metabolic acidosis, and residual renal function influence potassium kinetics during dialysis. Materials and methods: An observational study analyzing pre- and post-dialysis serum potassium concentrations, the presence of residual urine output, and the cause of cardiovascular death; an acid concentrate containing 2 mmol/L of potassium was used. Results: Thirty-five patients were studied, with a predominance of males (62.9%) and individuals aged ≥65 years (60%). The primary etiology was diabetes mellitus (51.4%). Serum potassium levels decreased significantly after dialysis (from 4.84±0.86 to 3.20±0.30 mEq/L; p<0.001), and post-dialysis hypokalemia (<3.5 mEq/L) was highly prevalent (88.6%). No significant association was found with the type of cardiovascular death (p=1.000) or with residual urine output (p=0.268), although the latter was more frequent in patients without residual urine output (92.3% vs. 77.8%). Spearman analysis showed that the duration of hemodialysis was inversely correlated with pre- and post-dialysis potassium levels (ρ=-0.392 and -0.382; p<0.05), and there was a strong positive correlation between the two potassium values ​​(ρ=0.756; p<0.001). No significant correlations were found between potassium levels and the cause of death or demographic variables (p>0.05). Conclusions: Post-dialysis hypokalemia was highly prevalent; although no significant association was found with residual urine output or cardiovascular mortality, it is necessary to individualize the potassium prescription in the dialysis fluid and monitor patients at higher risk of potassium balance disturbances.
Fausto Giler, L Zambrano, V Aragundi, M Pita, R Macías, G Tamayo, Jorge Quinchuela, L Briones.
Copyright (c) 2026 Fausto Giler, L Zambrano, V Aragundi, M Pita, R Macías, G Tamayo, Jorge Quinchuela, L Briones. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Relationship between arteriovenous fistula stenosis and neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in hemodialysis patients.
Introduction: Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis, although they can be complicated by stenosis secondary to chronic inflammatory processes. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been proposed as accessible inflammatory markers. The objective was to evaluate their association with AVF stenosis in hemodialysis patients. Materials and methods: A multicenter observational study was conducted on 42 incident patients with autologous or prosthetic AVFs in hemodialysis units in Quito (June 2024–October 2025). Clinical, ultrasound, and laboratory variables were collected. Stenosis was defined via Doppler ultrasound (resistance index >0.7). Descriptive analyses and multivariable logistic regression were performed. Results: Age ranged from 33 to 77 years, and 60% were men. 91% had an autologous AVF, and 83% had a brachiocephalic AVF. Seventeen cases of stenosis (40.48%) were identified, primarily in the middle third. In the multivariate analysis, the minimum PLR showed a significant association with stenosis, whereas the NLR was not significant. Hemoglobin was independently associated with a lower risk of stenosis (OR=0.42; p=0.022). Additionally, a significant interaction was observed between diabetes and NLR (p=0.034), demonstrating that the effect of NLR varies depending on the presence of diabetes (see Table 1). Conclusions: AVF stenosis is primarily associated with hematological and inflammatory alterations; the PLR ​​stands out as a relevant marker, and hemoglobin as a protective factor. The NLR showed an effect dependent on the presence of diabetes. These findings suggest that inflammatory indices can serve as complementary tools in vascular access surveillance, although they are not sufficient in isolation.
Gabriela Tamayo, Jorge Quinchuela, Pamela Campaña, Natalia Benavides, Ilen Corrales, Leonor Briones.
Copyright (c) 2026 Gabriela Tamayo, Jorge Quinchuela, Pamela Campaña, Natalia Benavides, Ilen Corrales, Leonor Briones. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Safety and survival benefit of very high extracorporeal flow (Qb of 600 mL/min).
Introduction: High-volume convective online hemodiafiltration (HDF-OL) (>24 liters) is considered the gold standard for optimizing the clearance of medium- and large-molecular-weight solutes in end-stage renal disease. Beyond this, there do not appear to be substantial improvements in survival outcomes. However, it is often assumed that extracorporeal blood flow (Qb)—which is the primary determinant of Kt/V—should remain below the convective volume, even though the latter can be optimized. Questions have traditionally been raised regarding whether prescribing extracorporeal flows of 500–600 mL/min via large-bore vascular access compromises the safety or long-term viability of the technique. Materials and Methods: A retrospective observational study was conducted using the institutional database. The study compared a historical group of patients undergoing high-volume HDF-OL (>22 liters/session; 2019–2023) with a prescribed optimal extracorporeal flow of 450–480 mL/min against adult patients undergoing HDF-OL (>22 liters) who transitioned to a high extracorporeal flow program (Qb = 600 mL/min) using an arteriovenous fistula. To achieve the target Qb of 600 mL/min, the flow rate was increased by 25 mL/min per treatment until the patient tolerated 600 mL/min by the end of six consecutive thrice-weekly sessions. Shear stress observed during the Qb escalation period was monitored. If shear stress occurred, the management strategy involved reducing the flow to 470 mL/min, administering intravenous analgesia (1 g paracetamol), pausing the progressive Qb increase, performing upper-limb exercises with weights and a tourniquet, and attempting the progressive increase again one week later. A survival analysis was performed. Results: There were 58 cases in group 1 and 50 in group 2. No differences were found regarding age, sex, percentage of diabetic patients, weight, or body mass index (Table 1). Survival was higher in the group with the higher extracorporeal flow, with a benefit of 37 months. Conclusions: Optimizing extracorporeal blood flow to very high levels (Qb approx. 600 mL/min) via a progressive increase in patients with an arteriovenous fistula undergoing high-volume online hemodiafiltration (HDF-OL) is a viable, safe strategy with an outstanding clinical impact. Far from compromising vascular access stability, this guided adaptation protocol was associated with a significant increase in patient survival (yielding a net benefit of 37 months compared to conventional optimal flow). These findings suggest a need to rethink traditional limits on extracorporeal blood flow, positioning very high Qb as a key therapeutic pillar for maximizing clinical outcomes in end-stage renal disease.
Very high extracorporeal flow (Qb of 600 mL/min).
Pamela Tatianna Morales Torres, Samantha Pineda, Adriana Chicaiza.
Copyright (c) 2026 Franklin Mora Bravo, Pamela Tatianna Morales Torres, Samantha Pineda, Adriana Chicaiza. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Prevalence of anxiety in patients with kidney disease and its associated factors based on Bronfenbrenner's ecological model.
Introduction: In patients with kidney disease, anxiety is considered a common emotional disorder due to significant life changes, the nature of the illness itself, and the urgent need to initiate hemodialysis to sustain life. The objective of this study was to identify existing research on the prevalence of anxiety among renal patients in Hispanic countries and the psychometric instruments used to assess this variable. Furthermore, applying Bronfenbrenner’s Ecological Model, the study aimed to highlight factors that could trigger and perpetuate anxiety disorders within this population. Materials and Methods: A literature review was conducted covering studies published over the last 10 years regarding anxiety prevalence in patients with kidney disease in Hispanic countries. These studies were sourced from databases such as SciELO, PubMed, Scopus, Springer, and Google Scholar, alongside two doctoral theses. Results: The review identified anxiety prevalence estimates among patients with chronic kidney disease ranging from 21.4% to 93% in Hispanic countries. Moderate to high severity levels predominated, with greater vulnerability observed in women and patients who had been on hemodialysis for longer periods. The most frequently used assessment tools were the Hospital Anxiety and Depression Scale (HADS), the Beck Anxiety Inventory (BAI), and the Hamilton Anxiety Rating Scale. Key factors linked to anxiety included clinical and biological variables (body mass index, comorbidities, and sleep disturbances) and psychosocial aspects (coping styles, loss of independence, role changes, and family support networks), as well as treatment-related stressors such as noise from hemodialysis equipment and financial costs. Urie Bronfenbrenner’s (1917–2005) Ecological Systems Theory—also known as the Ecological Model—allows for the identification and evaluation of elements within the person-environment dyad that exert a direct or indirect influence. Conclusions: The prevalence of anxiety among renal patients was corroborated by the findings of studies used in this work, confirming a high incidence rate of this emotional disorder. Assessing the emotional state of individuals with chronic kidney disease undergoing hemodialysis is essential. Bronfenbrenner’s Ecological Model offers a valid and transferable alternative for research and psychological practice (psychodiagnosis and psychotherapy) involving renal patients. In Ecuador, scientific evidence regarding psychological practice for this population remains scarce.
Copyright (c) 2026 Mónica Castro Ponce, Erika López López (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Anxiety in patients with renal disease undergoing hemodialysis.
Introduction: Facing kidney disease entails a multitude of changes and reactions in patients; negative emotional states, such as anxiety, are common (Sánchez et al., 2018). Anxiety is highly prevalent in this population group (Goh & Griva, 2018). Chronic illness gives rise to "paranormative" crises—unexpected, non-normative life events—that impact various areas of human functioning. The objective of this study was to determine the presence of anxiety in patients with kidney disease undergoing hemodialysis. Materials and Methods: This was a quantitative, cross-sectional, non-experimental study using non-probability convenience sampling. The sample consisted of 94 patients treated at the Socihemod Santo Domingo Clinic in 2022. Instruments included the State-Trait Anxiety Inventory (STAI/IDARE), a sociodemographic profile, and informed consent forms; a review of existing literature was also conducted. Results: State and trait anxiety were present in more than 50% of the patients. Male patients exhibited high levels in both anxiety categories. Among women, a high level of trait anxiety predominated (62%). High state anxiety was observed in over 50% of patients with either type of vascular access. Moderate trait anxiety was found in patients with fistulas, while high trait anxiety was found in those with catheters. Patients undergoing treatment for a duration of 3 months to 1 year scored high on both state and trait anxiety, with state anxiety being predominant. Conclusions: Anxiety is an emotional disorder affecting patients with kidney disease. State and trait anxiety are present in more than 50% of patients with chronic renal failure undergoing hemodialysis at the Socihemod Santo Domingo Clinic; moderate and high levels are significantly elevated. Patients with fistulas and those with catheters alike report high levels of both state and trait anxiety. Regarding the duration of hemodialysis and manifestations of anxiety, this could be considered within the range of psychological adaptation and acceptance of the medical treatment and lifestyle changes.
Patients with renal disease undergoing hemodialysis
Antiproteinuric response to finerenone in diabetic kidney disease: analysis of responders and non-responders in the Latin American FINDKDLATAM cohort.
Introduction: Type 2 diabetes mellitus (T2DM) is the leading cause of chronic kidney disease (CKD). Albuminuria is a marker of kidney damage, and its reduction is a therapeutic goal. Finerenone has demonstrated cardiorenal benefits in patients with CKD associated with T2DM; however, there is variability in the magnitude of the antiproteinuric response. Objective: To describe the clinical profile associated with a greater antiproteinuric response to finerenone in patients with CKD associated with T2DM by analyzing responders and non-responders from the FINDKDLATAM cohort. Materials and Methods: A subgroup analysis including patients with CKD associated with T2DM from seven countries. Patients were classified as absolute responders (≥50% reduction in UACR), partial responders (30% to 49% reduction), and non-responders (<30% reduction) at the 6-month follow-up. Sociodemographic, clinical, biochemical, and therapeutic variables, as well as safety data, were analyzed. Results: Of the 347 patients in the original cohort, 334 had complete data. 80.2% (n = 268) were absolute responders, 11.7% (n = 39) were partial responders, and 8.1% (n = 27) were non-responders. Among absolute responders, UACR decreased from 350.7 mg/g to 67.0 mg/g, an 81.4% reduction (p < 0.0001). Among partial responders, UACR fell from 240.5 mg/g to 143.0 mg/g, a 40.5% reduction (p < 0.0001). No significant changes were observed in non-responders. eGFR remained stable in responders, whereas a significant decline was observed in non-responders. A modest increase in serum potassium was observed, without reaching clinically relevant levels of hyperkalemia. The combination of finerenone and SGLT2 inhibitors showed the highest proportion of absolute responders (98.6%). Conclusions: In this Latin American cohort of patients with diabetic kidney disease (DKD), 90% demonstrated a positive antiproteinuric response and a favorable safety profile, regardless of baseline clinical characteristics. No specific clinical profile associated with a higher likelihood of response was identified, suggesting that the antiproteinuric benefit of finerenone may be observed across a broad spectrum of patients with diabetic kidney disease.
Jorge Rico Fontalvo, María Raad Sarabia, Vicente Sánchez Polo, Giovanny Mera Rebutti, James J. Muñoz Zambrano, Washington Osorio, Rodrigo Daza Arnedo.
Copyright (c) 2026 Jorge Rico Fontalvo, María Raad Sarabia, Vicente Sánchez Polo, Giovanny Mera Rebutti, James J. Muñoz Zambrano, Washington Osorio, Rodrigo Daza Arnedo. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Associated factors and economic impact of vascular access infections in hemodialysis patients.
Introduction: Vascular access-associated infections (VAAIs) are a frequent complication that increases morbidity and mortality and imposes an economic burden. Their clinical and microbiological profiles, as well as their financial impact, vary depending on the type of vascular access and the causative agent. Objective: To identify factors associated with VAAIs and estimate the economic impact among patients at six dialysis centers in Ecuador. Materials and Methods: This was a multicenter, cross-sectional, observational study involving 140 patients with VAAIs between July 2024 and June 2025. Demographic and clinical variables, vascular access type, microbiological profile, direct costs, and clinical outcomes were analyzed. Statistical analyses included Kruskal-Wallis and chi-square tests, Pearson and Spearman correlation tests, and nominal logistic regression. Results: Males predominated (57.1%), with a mean age of 63.19 ± 13.4 years. Diabetes mellitus was the primary cause of chronic kidney disease (60.7%). Permanent catheters accounted for 80.7% of the infections, primarily located in the right jugular vein (62.9%). Hospitalization was required for 33.6% of patients, and 40% underwent surgical procedures. No differences in costs were observed based on the type of access (p≥0.05); however, Gram-positive infections increased medication costs by 35% to 41% (p<0.001). A correlation was found between the duration of treatment and total cost (rₛ=0.499; p<0.001). In the multivariate model, the type of vascular access was the main independent predictor of the type of pathogen (p=0.029), while age showed a borderline effect (p=0.050). Conclusions: VAAIs are predominantly associated with permanent catheters and result in high healthcare resource utilization. The type of vascular access is the primary determinant of the microbiological profile, whereas the economic impact depends mainly on the type of bacteria and the duration of treatment.
Janette López Crespo, Mónica de las Salas Barroso, Eusebio Martínez Porras, Patricia Ronquillo Tutiven, Patricia Llerena Montenegro, Jorge Quinchuela, Pesantez S, Vélez C.
Copyright (c) 2026 Mónica De Las Salas Barroso, Janette López Crespo, Mónica de las Salas Barroso, Eusebio Martínez Porras, Patricia Ronquillo Tutiven, Patricia Llerena Montenegro, Jorge Quinchuela, Pesantez S, Vélez C. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Liver transplantation in autosomal dominant polycystic disease with renal and hepatic involvement
Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disorder, characterized by the progressive growth of cysts. Polycystic liver disease (PLD) is its most frequent extra-renal manifestation. Although liver function is usually preserved, massive organ enlargement causes severe compressive symptoms that significantly impair quality of life. Materials and Methods: We describe the clinical case of a 44-year-old female patient with ADPKD and severe hepatic involvement, treated at Bonsucesso Hospital in Rio de Janeiro, Brazil. Clinical management, imaging findings (abdominal CT), and post-transplant outcomes were analyzed, complemented by a review of the Gigot and Schnelldorfer classifications to determine disease severity and therapeutic approach. Results: The patient presented with early satiety, gastroesophageal reflux, and a 10 kg weight loss, while maintaining normal renal and hepatic function (GFR 94 mL/min/1.73 m²). CT imaging revealed massive hepatomegaly and enlarged kidneys (Mayo Classification 1C) causing compression of adjacent organs. She underwent deceased-donor liver transplantation using MELD exception criteria (initial score of 20). The explanted liver weighed 4,440 g. Following the procedure, the patient experienced complete resolution of compressive symptoms and maintained renal stability (post-transplant GFR 113 mL/min/1.73 m²) while on immunosuppression with tacrolimus and mycophenolate. Conclusions: Liver transplantation is the only curative treatment for severe PLD with refractory symptoms. Early diagnosis is vital for considering timely therapeutic options, and transplantation is an effective intervention for restoring patient well-being, even when biochemical organ function remains preserved.
Danny García Ordóñez, Luis García Ordóñez.
Copyright (c) 2026 Javier Gonzalo Carrión Cano, Danny García Ordóñez, Luis García Ordóñez. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Super-high-flux hemodialysis versus high-flux hemodialysis in an Ecuadorian dialysis population.
Introduction: Survival and quality of life (QoL) in hemodialysis (HD) patients are affected by the retention of middle-molecular-weight toxins (MMWTs). Super-high-flux hemodialysis (HDs), utilizing medium cut-off (MCO) membranes, optimizes the clearance of these toxins compared to high-flux hemodialysis (HD-AF). The objective was to compare clinical, anthropometric, QoL, and clearance parameters between the two modalities. Materials and Methods: A randomized, controlled, crossover experimental study was conducted in Ecuador involving 159 patients. Subjects were assigned to two groups, alternating between HDs and HD-AF over six-month periods. Elisio HX (HDs) and Elisio H (HD-AF) dialyzers were used alongside ultrapure dialysis fluid. Statistical analysis compared mean differences using independent-samples t-tests (α=0.05). Results: The study population was predominantly male (65.4%) and aged 40–64 years (54.8%). HDs demonstrated significant improvement in overall QoL compared to HD-AF (2.84 vs. -1.49; p=0.000), with specific benefits regarding general health and disease burden. Significant reductions were observed in parathyroid hormone (PTH) (-52.05 vs. 64.96 pg/mL; p=0.009) and C-reactive protein (CRP) (-2.39 vs. 1.99 mg/L; p=0.020) with HDs. Additionally, fat mass decreased significantly (-1.93 vs. -0.75 kg; p=0.008), and serum iron levels increased (12.09 vs. 3.21 mcg/dL; p=0.023) with the use of HDs. Conclusions: The transition from HD-AF to HDs results in an increase in perceived quality of life and serum iron levels, as well as a decrease in PTH, CRP, and fat mass levels. These findings suggest that HDs offers superior clinical advantages in the comprehensive management of patients with advanced chronic kidney disease.
Borges Colina Mariant, Bacallao Méndez Raymed, Cedeño Mendoza Christian, Sánchez Ruiz Narcisa.
Copyright (c) 2026 José Dorta Díaz, Borges Colina Mariant, Bacallao Méndez Raymed, Cedeño Mendoza Christian, Sánchez Ruiz Narcisa. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Functional Impact of Needle Gauge (14G vs. 15G) on High-Flux Hemodialysis Efficiency.
Introduction: Effective blood flow (Qbe) is the critical determinant of uremic toxin clearance in hemodialysis (HD). This study analyzes the clinical impact of increasing the gauge of needles used for autologous arteriovenous fistulas (AVF)—from 15G to 14G—on high-flux hemodialysis efficiency and short-term complication rates. Materials and Methods: A multicenter, controlled, quasi-experimental study was conducted in Ecuador (2025) involving 83 adult patients undergoing high-flux hemodialysis (HF-HD). Each subject completed 12 consecutive sessions (6 using 15G needles and 6 using 14G needles). Kinetic flow rates, circuit pressures (arterial, venous, and transmembrane), recirculation rates, dialysis dose (Kt/V, Kt), hemostasis time, and pain levels (measured via the Visual Analog Scale, VAS) were analyzed. Results: The use of 14G needles resulted in a statistically significant increase (p=0.00) in pump flow (444.8 vs. 381.3 mL/min) and effective flow (419.2 vs. 352.9 mL/min), thereby increasing the dialysis dose (Kt/V: 1.99 vs. 1.84; Kt: 70.8 vs. 66.2 L). Recirculation decreased significantly with 14G needles (6.95% vs. 8.42%; p=0.01). Pre-pump arterial pressures (–148.7 vs. –187.0 mmHg) and venous pressures (154.0 vs. 174.6 mmHg) were substantially less extreme with the larger-gauge needles. Perceived pain was lower with 14G needles (1.81 vs. 2.05; p=0.00), although hemostasis times were slightly longer (6.0 vs. 5.3 min; p=0.00). Conclusions: In high-flux hemodialysis (HF-HD), 14G needles increase blood flow rate (Qbe)—and consequently Kt/V—and reduce physical stress on the extracorporeal circuit. This promotes safe arterial and venous pressures that positively impact arteriovenous fistula (AVF) survival and patient quality of life, without increasing pain and with only a slight increase in hemostasis time.
José Dorta Díaz, Mariant Borges Colina, Raymed Bacallao Méndez, Arnaldo López Montañez, William López Vélez, Narcisa Sánchez Ruiz.
Copyright (c) 2026 José Dorta Díaz, Mariant Borges Colina, Raymed Bacallao Méndez, Arnaldo López Montañez, William López Vélez, Narcisa Sánchez Ruiz. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Effect of an oral amino acid supplement on nutritional and inflammatory parameters in hemodialysis patients.
Introduction: Protein-energy wasting (PEW) and chronic inflammation significantly increase morbidity and mortality in hemodialysis (HD) patients. This study evaluates the clinical impact of oral supplementation with a specific amino acid solution (RENORAL®, 150 mL; 13 g of protein per session) over 6 months on body composition, inflammatory biomarkers, functional capacity, and quality of life (QoL). Materials and methods: A prospective, randomized, controlled 6-month study involving 40 chronic HD patients, divided into two arms: the Renoral® group (n = 20) and the control group (n = 20). Clinical and laboratory assessments were performed at baseline and at months 3 and 6. Primary variables analyzed were lean body mass, handgrip strength, and C-reactive protein (CRP); secondary variables included serum albumin, weekly erythropoietin (EPO) dose, dialysis adequacy (Kt/V), and QoL scores. Results: After 6 months, the Renoral® group showed statistically significant improvements compared to baseline and the control group (p < 0.05): lean mass increased from 18.65 kg to 20.37 kg (+9%; p < 0.05), fat mass decreased (6.82 kg to 5.22 kg), handgrip strength improved (+18%; p < 0.05), and CRP decreased (10.19 mg/L to 6.22 mg/L; p < 0.05), whereas it increased in the control group (4.38 mg/L to 7.64 mg/L). QoL improved significantly in the Renoral® group (92.55 to 95.61; p < 0.05) compared to the control group (89.83 to 91.44), with a reduction in the erythropoietin dose at 3 months in the intervention group (3520 IU to 3300 IU). Conclusions: Nutritional supplementation with Renoral® for 6 months reduces systemic inflammation and PEW, optimizing muscle mass, functional strength, and quality of life in patients undergoing chronic hemodialysis, thereby serving as an effective intervention to improve prognostic indicators.
Azar R, Dorta A, Borges M, Cedeño C, Sánchez N.
Copyright (c) 2026 Azar R, Dorta A, Borges M, Cedeño C, Sánchez N. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Impact of gentamicin locking on central venous catheter-associated infection in hemodialysis patients
Introduction: Central venous catheter (CVC)-associated infection is a major complication in patients undergoing hemodialysis, increasing morbidity and mortality, healthcare costs, and hospitalizations. Various preventive strategies have been implemented to reduce its incidence, including intraluminal antibiotic locking. The aim of this study was to identify factors associated with CVC-related infection and to evaluate the efficacy of the gentamicin locking protocol implemented at FREIAT starting in 2022. Methods: A retrospective observational study was conducted at a hemodialysis unit in Ecuador (FREIAT). Records of 197 patients with CVCs from 2017 to 2026 were analyzed. Variables evaluated included demographics, comorbidities, nutritional status, personal hygiene, catheter dwell time, and the use of gentamicin locking starting in 2022. Descriptive and comparative analyses were performed, using tests of association, to determine factors linked to the presence of infection. Results: A total of 197 infection episodes were analyzed. The mean age was 58.6 ± 17.7 years, and 57.1% of the patients were female. Arterial hypertension was present in 87.3% of cases, and diabetes mellitus in 48.2%. The mean catheter dwell time was 14.7 ± 13.6 months. Of the 197 episodes evaluated, 78 (39.6%) yielded positive cultures and 119 (60.4%) yielded negative cultures. The isolated microorganisms were predominantly Gram-negative bacilli, notably Escherichia coli, Enterobacter spp., and Klebsiella pneumoniae. Among Gram-positive cocci, the most frequent microorganisms were coagulase-negative Staphylococcus and Staphylococcus aureus. When comparing episodes based on the use of gentamicin lock therapy, the proportion of positive cultures was 41.5% in patients without the lock and 36.7% in those who received the gentamicin lock, representing a relative reduction of 11.6%. However, this difference did not reach statistical significance (p=0.597). It should be noted that, following gentamicin use, there were 7 cases of coagulase-negative *Staphylococcus* isolation that could be considered external contamination; additionally, 6 episodes did not involve gentamicin lock therapy for various reasons, and a culture sample taken from one newly admitted patient tested positive. Following the implementation of the protocol, a progressive decrease in the annual number of infections was observed, dropping from 16 episodes in 2022 to 8 in 2023, 4 in 2024, 4 in 2025, and zero during the analyzed period of 2026. Furthermore, a trend toward lower serum albumin levels was observed in infected patients. Poor personal hygiene was significantly associated with a higher percentage of infections. The majority of episodes occurred in tunneled jugular catheters. However, from an epidemiological standpoint, this does not necessarily imply a higher risk, as these are also the most frequently used catheters in the unit. "Tunneled jugular catheters were the most common vascular access in the recorded infection episodes." Conclusions: Prophylactic gentamicin locking was associated with a significant reduction in CVC-related infections in hemodialysis patients. Gram-negative bacilli were the predominant microorganisms, with Escherichia coli and Enterobacter spp. being the most frequently isolated agents. Poor personal hygiene and prolonged catheter dwell time emerged as significant risk factors. These findings support the continued use of the gentamicin locking protocol as an effective prevention strategy in hemodialysis units.
Nelson Rojas C, Francisca Chavarría B, Carlos Villacis, Claudina González B, Denisse Marriott B, Irvin Rojas C, Guillermina Blum C.
Copyright (c) 2026 Nelson Rojas C, Francisca Chavarría B, Carlos Villacis, Claudina González B, Denisse Marriott B, Irvin Rojas C, Guillermina Blum C. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Pregnancy on Peritoneal Dialysis with Systemic Lupus Erythematosus and Chronic Renal Failure
Introduction: Pregnancy in women undergoing peritoneal dialysis (PD) represents an exceptional and highly complex clinical scenario. The coexistence of Systemic Lupus Erythematosus (SLE) and chronic kidney disease (CKD) significantly worsens the maternal-fetal prognosis. Peritoneal dialysis during pregnancy offers advantages over hemodialysis by avoiding abrupt hemodynamic fluctuations and providing continuous solute clearance. Case Report: A 20-year-old Ecuadorian woman with SLE (diagnosed in 2021), arterial hypertension, and stage 5 CKD—on automated PD since September 2023—was diagnosed with a 14-week pregnancy in April 2024. Dialysis was intensified to the "Tidal" modality with a total volume of 4,000 mL/day. Follow-up was multidisciplinary (nephrology, PD nursing, obstetrics, rheumatology, nutrition, and psychology). The SLE remained serologically inactive. Biochemical parameters stayed within acceptable ranges throughout the pregnancy. The patient progressed favorably, resulting in a successful delivery and a return to conventional PD postpartum. Results: A female infant weighing 1,480 g, measuring 50 cm in length, with a head circumference of 29 cm, was delivered via lower-segment cesarean section at 32 weeks and 5 days of gestation. The patient’s clinical course was generally favorable throughout the pregnancy, with the exception of blood pressure elevations three days prior to delivery; however, there were no events related to active immune disease. Conclusions: This case demonstrates that pregnancy in patients with PD and SLE can be successfully managed through early dialysis intensification and strict multidisciplinary follow-up. Key elements include: early initiation of intensive monitoring upon pregnancy diagnosis, intensification of PD, SLE in serological remission, continuous nutritional and psychological support, and a multidisciplinary team approach (nephrology, PD nursing, obstetrics, rheumatology, nutrition, and psychology). The published experience is limited to a series of cases and isolated reports; this represents a significant contribution to the scarce published evidence regarding pregnancy in patients with SLE and CKD undergoing peritoneal dialysis.
José Dorta Díaz, Mariant Borges Colina, Maricarmen Rodríguez Morales, Yetel Ortiz Figaredo.
Copyright (c) 2026 José Dorta Díaz, Mariant Borges Colina, Maricarmen Rodríguez Morales, Yetel Ortiz Figaredo. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Hyponatremia as an indicator of central nervous system cryptococcosis in renal transplant recipients
Introduction: Cryptococcosis is a major invasive fungal infection in kidney transplant recipients and is associated with high morbidity and mortality, particularly when it involves the central nervous system. Its clinical presentation is often nonspecific, which can delay diagnosis. Evidence regarding the association between hyponatremia and central nervous system cryptococcosis in this population is limited. Materials and methods: A retrospective study of two cases of central nervous system cryptococcosis in kidney transplant recipients with hyponatremia. Demographic variables, transplant characteristics, immunosuppression regimens, clinical presentation, biochemical and microbiological findings, antifungal treatment, and clinical outcomes were analyzed. Results: Two cases of late-onset central nervous system cryptococcosis were documented, diagnosed 6 and 12 years after kidney transplantation. The patients were receiving maintenance immunosuppression with tacrolimus, mycophenolate, and prednisone. Both presented with neurological manifestations associated with hyponatremia upon admission. Diagnosis was confirmed via multiplex PCR of cerebrospinal fluid, direct examination with India ink, and isolation of *Cryptococcus neoformans* in culture. Induction therapy consisted of amphotericin B and fluconazole, adjusted based on therapeutic availability. Regarding clinical outcomes, one patient achieved neurological recovery. The second patient showed partial improvement during hospitalization but died at home three months later—during the consolidation phase—while receiving fluconazole treatment. Conclusions: The late onset of central nervous system cryptococcosis in kidney transplant recipients underscores the need to maintain a high index of clinical suspicion beyond the period of peak immunosuppression. The coexistence of hyponatremia and neurological manifestations may indicate central nervous system cryptococcosis and should prompt early microbiological investigation to establish a diagnosis and initiate timely antifungal treatment.
Jenniffer Mireya Gallo Muñoz, Wilter Ferrín Flores de Vargas, Alexis Mauricio Lindao Arana.
Copyright (c) 2026 No listed (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Prevalence of sarcopenia according to EWGSOP2 criteria in hemodialysis patients
Introduction: Sarcopenia is a common condition in patients with chronic kidney disease (CKD) undergoing hemodialysis; it is associated with increased mortality, hospitalizations, and impaired quality of life. Timely identification enables diagnosis and the implementation of early interventions. The objective was to determine the prevalence of sarcopenia and its diagnostic components in hemodialysis patients. Materials and methods: An observational, descriptive, cross-sectional study was conducted. The study included 180 hemodialysis patients from two renal units in El Oro province. Assessments included the SARC-F questionnaire, handgrip strength (via hand dynamometry), physical performance (via the 5-repetition Sit-to-Stand test [STS-5]), and body composition (via multifrequency bioimpedance [BCM]). Sarcopenia diagnosis was established according to EWGSOP2 criteria. Results: The sample consisted of 112 men (62.2%) and 68 women (37.8%), with a predominance of the 51–70 age group. The prevalence of sarcopenia was 10.56%, and the prevalence of severe sarcopenia was 6.1%. The SARC-F questionnaire indicated a high probability of sarcopenia in 63 patients (35%) and a low probability in 117 patients (65%). Regarding handgrip strength, the 10th percentile was the most frequent category (31.1%; n=56). The STS-5 test revealed moderate dysfunction in 37.2% (n=67) and severe dysfunction in 38.2% (n=59); a statistically significant association was found between severe dysfunction and the presence of sarcopenia (p = 0.001; p < 0.05). Conclusions: A high risk of developing sarcopenia was observed in hemodialysis patients. Physical performance, as measured by the STS-5 test, was significantly associated with the prevalence of sarcopenia, highlighting its utility as a functional screening tool in this population.
Piedra G, Rentería I, Mero J, Fernández B, Yaulema N, Mantilla S, Díaz J, Ortiz L.
Copyright (c) 2026 Piedra G, Rentería I, Mero J, Fernández B, Yaulema N, Mantilla S, Díaz J, Ortiz L. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Association between the use of agricultural chemicals and the development of idiopathic chronic kidney disease in hemodialysis patients from four clinics in Guayas.
Introduction: Chronic kidney disease of non-traditional etiology (CKDnt) represents a growing problem in agricultural populations exposed to environmental and chemical factors. Prolonged exposure to agrochemicals has been proposed as a possible risk factor for the development of CKDnt, although the association has not yet been fully established. Materials and Methods: An observational, retrospective, longitudinal cohort, and analytical study was conducted across four dialysis centers. A total of 882 hemodialysis patients were included; of these, 295 met the inclusion criteria and had a diagnosis of CKDnt. Sociodemographic variables, occupational history, and exposure to agricultural chemicals were analyzed. The association between exposure and CKDnt was evaluated using the Odds Ratio (OR) and 95% confidence interval (CI), with a statistical significance level of p<0.05. Results: Patients exposed to chemicals were predominantly male (93%), rural residents (80%), and farmers prior to starting dialysis (88%). In this group, CKDnt was the most frequent etiology (45%). Among the non-exposed group, type 2 diabetes mellitus predominated (33%). Of the patients with CKDnt, 67% were farmers and 76% resided in rural areas. Ninety-seven percent of the exposed patients had more than 10 years of exposure. Bivariate analysis showed that exposure to agricultural chemicals increases the risk of CKDnt (OR=260; 95% CI: 256.64–6186.07; p<0.001) and that exposure lasting 10 years or more increases the risk (OR=416; 95% CI: 135.99–1273.65; p<0.001). Conclusiones: Existe una asociación significativa entre la exposición prolongada a químicos agrícolas y el desarrollo de ERCI en pacientes hemodializados, especialmente en trabajadores agrícolas con más de 10 años de exposición. La exposición prolongada, la falta de uso de medidas de bioseguridad; determinan escenarios sombríos para esta población. Estos hallazgos respaldan la necesidad de estrategias preventivas en poblaciones rurales expuestas.
García Ordóñez Danny, García Cedeño Paola, Marcano Díaz Virginia, Villarreal Quintero Jorge, Pazmiño Rojas Dorys.
Copyright (c) 2026 García Ordóñez Danny, García Cedeño Paola, Marcano Díaz Virginia, Villarreal Quintero Jorge, Pazmiño Rojas Dorys. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Nephrotic syndrome secondary to focal segmental glomerulosclerosis in a patient with controlled HIV
Introduction: Focal segmental glomerulosclerosis (FSGS) is a leading cause of nephrotic syndrome in adults and contributes significantly to the progression of chronic kidney disease. In patients with HIV infection, glomerulopathies are typically associated with active viral replication and immune deterioration; however, their occurrence in individuals with sustained virologic suppression poses a diagnostic and therapeutic challenge. We present the case of a young patient with controlled HIV who developed nephrotic syndrome secondary to biopsy-confirmed FSGS. Case report: We report the case of a 31-year-old mixed-race man with a history of HIV infection since 2016, on continuous treatment with abacavir/lamivudine and dolutegravir, with a persistently undetectable viral load and adequate immune reconstitution. Medical history, laboratory tests, renal ultrasound, and renal biopsy findings were reviewed to establish the diagnosis and initiate treatment. Results: The patient presented with nephrotic-range proteinuria (5.1 g/24 h), creatinine levels between 1.46 and 1.87 mg/dL, and an immunological profile negative for autoimmune diseases. Ultrasound showed kidneys of preserved size with altered corticomedullary echogenicity and bilateral non-obstructive lithiasis. Renal biopsy confirmed FSGS with interstitial fibrosis and mild tubular atrophy (20%). Treatment with losartan, spironolactone, empagliflozin, prednisone, and tacrolimus was initiated while maintaining antiretroviral therapy; the patient maintained an undetectable viral load and immunological stability. Conclusions: FSGS can occur in patients with adequately controlled HIV infection, even in the absence of viral replication and with high CD4 lymphocyte counts, although this presentation is less common than classic HIV-associated nephropathy (2–4). The renal biopsy was crucial for establishing the diagnosis and guiding immunosuppressive treatment, highlighting the importance of considering other etiologies of nephrotic syndrome in people with HIV and conducting a comprehensive nephrological evaluation to optimize management and preserve renal function (1,4).
Copyright (c) 2026 Karla Amanda Manzano Bayas, Karla Gabriela Ramos Burgos, Nieve Karina Peña Ponce (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Some Observations on Hypertension and the Kidney.
The author warns about the worrying tendency to underestimate the control of high blood pressure (hypertension) in patients with kidney disease, in favor of other analytical parameters. He emphasizes that blood pressure measurements taken in the doctor's office are often unreliable due to the "white coat effect" and limited technical expertise. Although ambulatory blood pressure monitoring (ABPM) is useful for assessing nighttime blood pressure, it has limitations, including insurance coverage restrictions, costs, and discomfort that disrupts sleep. To overcome this medical "comfort zone," the author proposes strict guidelines for accurate measurement: Protocol: Sit with back support, feet flat on the floor, right arm completely bare, at heart level, at rest, and without talking. Measurements taken while lying down are unreliable. Device: Avoid mercury and uncalibrated aneroid sphygmomanometers. Validated digital upper-arm blood pressure monitors are recommended, with cuffs appropriate to the arm size (or universal cuffs) to avoid overestimating readings. As a primary solution, home blood pressure monitoring (HBPM) performed by the patient is promoted. This method is as effective as ambulatory blood pressure monitoring (ABPM) but offers the advantage of reflecting daily life, allowing unlimited repetitions, and fostering patient engagement with their condition. Given the lack of strict consensus, the author suggests a 5-day protocol (with 3 daily readings before meals), discarding the first two days and averaging the remaining readings to ensure a reliable diagnosis.
Copyright (c) 2026 Cristian Krämer (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Epidemiological profile of glomerulopathies in adults
Introduction: This cross-sectional study aims to determine the prevalence of different types of glomerulopathy among patients aged 18 years or older who underwent renal biopsy at the Metropolitan Hospital of Quito from January 2019 to August 2024. Materials and methods: Reports of renal biopsies performed between January 2019 and August 2024 were reviewed. All adult patients aged 18 years or older who underwent a renal biopsy during this period were included. Histological diagnoses were classified according to the World Health Organization (WHO) classification, and their overall prevalence was evaluated, as well as their prevalence by gender and age. Results: A total of 168 renal biopsies were analyzed, revealing a gender distribution of 58.33% male and 41.67% female, with a mean age of 46.81 ± 16.79 years. The most frequent glomerulopathy was focal segmental glomerulosclerosis (FSGS), with a prevalence of 22.49% across all age groups. Other common diagnoses included IgA nephropathy and membranous glomerulonephritis, both with a prevalence of 13.1%. Among those under 40 years of age, lupus nephritis was the most prevalent at 22.54%, whereas among those over 65 years of age, FSGS was the most prevalent at 31.25%. Additionally, lupus nephritis (27.14%) was more prevalent in women compared to men, who presented with focal segmental glomerulosclerosis (25.56%). Conclusions: Primary glomerulopathies are the third leading cause of chronic kidney disease worldwide. These conditions are potentially treatable if diagnosed early, which can prevent their progression and the subsequent need for dialysis. This study provides valuable information on the distribution and prevalence of glomerulopathies, which is essential for improving diagnosis and treatment in our setting.
Copyright (c) 2026 Andrea Portilla, Washington Osorio , Alex Siza Duarte, Andrés Arteaga-Arellano, Francisco Xavier Castro Vega, María Elena Urresta Avila, Fernando Jimenez, Verónica Remache (Author) https://creativecommons.org/licenses/by-nc-sa/4.0