Background: The arteriovenous fistula (AVF) is a commonly used vascular access for chronic kidney disease (CKD) patients; exercise interventions may boost its maturation and help in its maintenance. A systematic review and meta-analysis of clinical trials on the effects of upper limb exercise programs on the AVF was conducted. Methods: The primary outcomes were draining vein diameter (DVD) and draining vein blood flow rate (DVBFR), and secondary outcomes were handgrip strength (HGS) and brachial artery flow rate (BAFR). Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: Four studies met the inclusion criteria. When compared to usual care groups, the experimental groups did not improve DVD (mean difference [MD] 0.23, confidence interval [CI] −0.20–0.65). There were significant differences in DVBFR (mL/min) according to the fixed-effect model (MD 141.13, CI 36.84–245.42). HGS (kg) was significantly different between groups (MD 2.95, CI 0.55–5.35), but BAFR (mL/min) was not (MD 91.65, CI −94.72–278.01). Conclusions: Although exercise programs did not improve DVD and BAFR, they increased muscle strength and DVBFR. Therefore, experimental exercise programs should be emphasized for AVF maturation and maintenance. Research Registry number: reviewregistry924.

Background Cardiorespiratory fitness seems to play an important role in the general health of patients undergoing hemodialysis (HD). However, the prediction of peak oxygen uptake (V̇O2peak) in a clinical setting is not widely adopted for these patients. Objectives Evaluate the agreement and reliability between directly and indirectly V̇O2peak measurements in patients undergoing HD. Methods This is a cross-sectional study with patients undergoing HD that performed a cardiopulmonary exercise test (CPET) with 5/10 watts incremental load in each minute using a cycle ergometry to directly evaluate the V̇O2peak, and the 6-min walk test (6MWT) in a 30-m corridor to indirect measures it. Both tests were performed on a midweek non-dialysis day. Bland–Altman analysis of agreement limits was used with direct and indirect V̇O2peak values. Intraclass correlation coefficient (ICC) and Cronbach’s Alpha was used to evaluate the reproducibility and reliability between direct and indirect V̇O2peak values. Results Twenty-six patients (54.4 ± 14.5 years, 53.8% of male) were evaluated. The V̇O2peak direct mean obtained through CPET was 15.91 ± 5.26 (ml/kg/min), while the indirect mean obtained through 6MWT was V̇O2peak of 14.89 ± 4.21 (ml/kg/min). There was a strong positive correlation between both V̇O2peak values (r = 0.734; p < 0.001). The Bland–Altman analysis demonstrated that the methods agreed with each other (p = 0.103). Also, the ICC (0.829) and Cronbach's Alpha (0.846) showed excellent reproducibility and reliability. Conclusions 6MWT is a reliable tool for estimating V̇O2peak in patients undergoing HD.

Frequentemente vemos e tratamos aqueles que se diferem de nós com preconceito, tratando-os de formas desiguais, menosprezando-os e estigmatizando-os, fazendo com que sejam deixados de lado em uma sociedade que considera apenas os semelhantes como normais. Objetivo: Analisar a produção científica sobre como é tratado o tema estigma na enfermagem nos anos de 2014 a 2021. Método: Revisão integrativa utilizando as bases de dados Scielo, LILACS e Portal Regional da BVS, com os descritores "estigma or stigma" AND "enfermagem or nursing". Resultados: Foram encontrados 372 artigos, e, após os critérios de inclusão e exclusão, foram utilizados 15

Background and Aims Kidney failure reduces life expectancy by one-third compared with the general population, and cardiovascular complications and poor cardiorespiratory fitness (CRF) are the main causes. We aimed to evaluate the association between severe CRF and all-cause mortality risk in HD patients. Method This observational prospective cohort study followed-up patients receiving HD from August 2015 until March 2022. Cardiorespiratory fitness was evaluated through the cardiopulmonary exercise test and the peak of oxygen uptake (VO2peak) value was used to determine severe CRF (&lt;15 mL·kg−1·min−1). Cox regression and Univariate Kaplan-Meier evaluated its association with mortality risk and survival rate. Results Forty-eight patients were followed-up for a median of 33.0 [14.3 – 49.3] months. A total of 26 patients had severe CRF. During the follow-up period, 11 patients (22.92%) experienced all-cause mortality. From these, eight (30.8%) had severe CRF. Even so, severe CRF was not associated with crude death rates for patients stratified by CRF levels (p = 0.189), neither in unadjusted (HR 2.35; CI 95% 0.61−9.15) and adjusted (HR 1.29; CI 95% 0.30−5.56) Cox proportional hazard models. As a continuous variable, each mL·kg−1·min−1 increase in VO2peak was not associated with mortality risk (HR 0.94; CI 95% 0.79−1.11). Univariate Kaplan-Meier analysis showed that severe CRF patients did not have significantly worse survival rates than those with mild-moderate CRF (p = 0.186). Conclusion Our findings indicated that severe CRF was not associated with all-cause mortality in patients receiving HD. Despite severe CRF being prevalent, larger cohort studies are needed to establish strong conclusions on its association with all-cause mortality.