The first case of the novel coronavirus disease (Covid-19) pandemic in Brazil was reported on February 26th, 2020, in São Paulo. On June 30th, Brazil ranked 2nd in the world in the number of cases, with 1.4 million victims officially reported and an average number of 37,600 new cases per day [Coronavirus disease case panel 2019 (COVID-19) in Brazil by the Ministry of Health. Available at: https ://covid .saude .gov.br/. Accessed June 27, 2020.]. Brazil is the third country in the world in the number of patients on chronic dialysis, with 133,500 in July, 2018 [2]. Ninety-two percent of them are on in-center hemodialysis (HD). A large number of kidney disease patients particularly those with kidney failure on dialysis are at a higher risk of complications of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection [3, 4]. The Brazilian Society of Nephrology, in conjunction with the Brazilian Association of Dialysis and Transplant Centers, has been conducting a national on-line survey of Covid-19 on kidney failure patients undergoing regular HD, since June 1st, 2020. In the present study, we describe the incidence, mortality, and fatality rates due to Covid-19 since the beginning of the outbreak until June 30th in a sample of 37,852 hemodialysis patients. Cases were considered confirmed if they had laboratory isolation of the SARS-CoV-2 by RT-PCR test from nasopharyngeal/oropharyngeal swabs. As of June 30th, there were 1,402,041 cases and 59,594 deaths reported in the overall Brazilian population [1, 5].

SUN dipsticks allow the discrimination of AKIN 3 from earlier AKI stages. This low-technology approach may aid the screening of severe AKI in areas where laboratory resources are scarce.

Dehydration associated with heat stress increases the risk of workplace injury or illness, decreases productivity, and may contribute to the chronic kidney disease epidemic identified in outdoor workers from hot climates. There is limited research on the effects of chronic occupational heat stress among indoor workers. We aimed to test the feasibility of measuring markers of hydration and kidney function in foundry factory workers in Southern Brazil, exposed and not exposed to heat stress. Factory workers exposed to heat stress (wet bulb globe temperature ≥28.9) and not exposed to heat were identified by management and invited to participate. Clinical and biochemical markers of hydration and kidney function were evaluated before and after a single 8.5 h work shift (lunch time not included). Feasibility outcomes included rates of enrolment, % completion of study protocols, and time to complete data collection. This study was deemed feasible with 80% enrolment and 90% completion of the protocol. Among the preselected workers, the enrolment rate was 91%. All subjects completed the physiological measures and blood collection and 95% completed the urine studies. Mean time to complete data collection pre-shift was 19.1 ± 4.2 min and post-shift: 14.3 ± 4.0 min. Workers exposed to heat stress had a greater decline in estimated glomerular filtration rate compared to controls over the work shift (–13 ± 11 vs. –5 ± 7 mL/min; p < 0.01). We demonstrated the feasibility and challenges of conducting future hydration and kidney function research among indoor factory workers. Further study is needed to determine if exposure to indoor heat contributes to a decline in kidney function.

Background: Acute kidney injury (AKI) is a growing global concern and often reversible. Saliva urea nitrogen (SUN) measured by a dipstick may allow rapid diagnosis. We studied longitudinal agreement between SUN and blood urea nitrogen (BUN) and the diagnostic performance of both. Methods: Agreement between SUN and BUN and diagnostic performance to diagnose AKI severity in AKI patients in the United States and Brazil were studied. Bland-Altman analysis and linear mixed effects models were employed to test the agreement between SUN and BUN. Receiver operating characteristics statistics were used to test the diagnostic performance to diagnose AKI severity. Results: We found an underestimation of BUN by SUN, decreasing with increasing BUN levels in 37 studied patients, consistent on all observation days. The diagnostic performance of SUN (AUC 0.81, 95% CI 0.63-0.98) was comparable to BUN (AUC 0.85, 95% CI 0.71-0.98). Conclusion: SUN reflects BUN especially in severe AKI. It also allows monitoring treatment responses. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=445041.

This retrospective multicenter (n = 18) cohort study evaluated the incidence, risk factors, and the impact of delayed graft function (DGF) on 1year kidney transplant (KT) outcomes. Of 3992 deceased donor KT performed in 2014-2015, the incidence of DGF was 54%, ranging from 29.9% to 87.7% among centers. Risk factors ( lower-bound-95%CI OR upper-bound-95% CI ) were male gender ( 1.066 1.249 1.463 ), diabetic kidney disease ( 1.053 1.296 1.595 ), time on dialysis ( 1.005 1.007 1.009 ), retransplantation ( 1.035 1.397 1.885 ), preformed anti-HLA antibodies ( 1.011 1.383 1.892 ), HLA mismatches ( 1.006 1.066 1.130 ), donor age ( 1.011 1.017 1.023 ), donor final serum creatinine (sCr) ( 1.239 1.317 1.399 ), cold ischemia time (CIT) ( 1.031 1.043 1.056), machine perfusion ( 0.401 0.542 0.733 ), and induction therapy with rabbit antithymocyte globulin (rATG) ( 0.658 0.800 0.973 ). Duration of DGF > 4 days was associated with inferior renal function and DGF > 14 days with the higher incidences of acute rejection, graft loss, and death. In conclusion, the incidence and duration of DGF were high and associated with inferior graft outcomes. While late referral and poor donor maintenance account for the high overall incidence of DGF, variability in donor and recipient selection, organ preservation method, and type of induction agent may account for the wide variation observed among transplant centers.