A good catheter implantation technique is important to allow effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with different techniques have been limited. The aim of this study was to investigate the rate of early catheter-related complications and catheter survival in two Brazilian centers, according to two different percutaneous methods of catheter implantation performed by nephrologist team. Adult incident patients recruited from January 2006 to July 2013 having undergone first peritoneal dialysis (PD) catheter implantation were included in the analysis. Mechanical and infectious early complication rates were defined as time to the first event occurring up to 3 months. Four hundred and forty-five consecutive Tenckhoff catheters were implanted by nephrologist team percutaneously after antibiotic prophylaxis in an operating room: trocar was used in 349 (78.4 %) and Seldinger technique (ST) in 99 (21.6 %). The ST was significantly associated with a lower rate of leak (16.3 vs 3 %, p = 0.03) and outflow failure due to tip catheter migration (22.6 vs 10.1 %, p = 0.04), while early infectious complication rates were similar between the two groups (p = 0.59). Long-term catheter survival was higher in Seldinger group (log-rank, p = 0.031). By Cox multivariate analysis, adjusted for age, sex, and diabetes, the ST remained independently associated with better catheter survival [HR 0.681 (0.462-0.910), p = 0.04]. As conclusion, our experience showed better PD outcomes with the ST than trocar method of catheter implantation by nephrologist.

Background: Catheter-related bloodstream infection (CR-BSI) is one of various complications related to hemodialysis (HD). As a result of the high rate of infection, the use of lock solutions for the prevention of CR-BSI has been studied. However, adverse effects of lock solution, such as increased emergence of strains resistant to antibiotics, which is an important concern, need to be investigated further. The aim of this study was to compare the efficacy of lock solution using a combination of cefazolin and gentamicin versus taurolidine and citrate in reducing CR-BSI in patients undergoing HD and to identify any adverse effects. Methods: A prospective observational study was performed at two dialysis centers. Patients using new tunneled central venous catheters (CVC) for HD were included. Patients with a tunneled CVC were assigned to receive either antibiotic lock solution (group 1: gentamicin 7 mg/ml + cefazolin 12 mg/ml + heparin 3500 IU/ml) or lock solution with TauroLock-Hep500 (group 2: taurolidine citrate 4% + heparin 500 IU/ml) during the inter-dialysis period. The patients were allocated to these groups according to the hemodialysis center they were attending. Results: A total of 145 CVCs were implanted in 127 patients and were followed for 15 months: 77 CVCs (65 patients) were placed in group 1 and 68 CVCs (62 patients) in group 2. There was no difference between the two groups with regard to CR-BSI (events per 1000 catheter-days: group 1 = 0.79, group 2 = 1.10; p = 0.18) or exit site infection rates (events per 1000 catheter-days: group 1 = 2.45, group 2 = 1.83; p = 0.37). The groups differed in ESI pathogens, with gram-positive oxacillin-resistant pathogens more frequent in group 1 (31.8% vs. 5.0%; p = 0.003). The two groups were similar in mechanical complications. In the Cox regression analysis, the internal jugular vein site was a protective factor for all catheter removal complications (hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.19-0.91) and mechanical complications (HR 0.16, 95% CI 0.065-0.41); only ESI was a risk factor for all catheter removal complications (HR 1.79, 95% CI 1.04-3.07) and mechanical complications (HR 5.64, 95% CI 1.65-19.3). Conclusions: The efficacy of both lock solutions was similar in preventing infections related to tunneled CVCs for HD. However, there were more oxacillin-resistant strains in patients who received antibiotic lock solution. Further studies are required to determine the optimal drug regimen and concentrations for lock solution and the associated adverse effects.

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O transplante renal é uma importante modalidade de terapia de substituição renal para pacientes portadores de doença renal crônica em estágios avançados. Doenças bucais, como processos infecciosos, inflamação crônica e outros fatores estão fortemente ligadas ao sucesso do transplante. Objetivo: Avaliar o impacto da saúde bucal na qualidade de vida de indivíduos com DRC, no período pré-transplante. Métodos: Foram avaliadas em 25 indivíduos em programação de transplante renal as alterações bucais, sialometria mecanicamente estimulada (SME) e não estimulada (SNE), condição periodontal pelo índice periodontal comunitário, índice gengival e de placa e aplicação do questionário de qualidade de vida OHIP- 14. Resultados: O ressecamento labial esteve presente em 14 (56%) casos, precedido de saburra lingual 10 (40%), língua fissurada 9 (36%), candidíase 7 (28%), atrofia de papilas linguais 4 (16%), palidez da mucosa 4 (16%) e 2 (8%) casos de abscesso periodontal agudo. A hipossalivação foi constatada em 17 (68%) pacientes que realizaram SNE e em 13 (52%) pacientes sob SME. A maioria dos pacientes possuía acúmulo de biofilme bacteriano e inflamação gengival moderada, com sangramento  à manipulação e edema, com 82% de sangramento à  sondagem, 88% com cálculo dentário e 52% com bolsa periodontal com sondagem entre 4 e 5 mm de profundidade. Na presente amostra, 32% dos pacientes tiveram médio impacto da saúde bucal sobre a qualidade de vida. Conclusão: Infecções bacterianas e fúngicas bucais foram achados comuns e podem estar relacionados   hipossalivação. Essas condições provocaram impacto negativo na qualidade de vida dos indivíduos em programação de transplante de rim.