Márcia Regina Camargo

INTRODUCTION: There are few reports in the literature estimating the epidemiologic characteristics of pediatric chronic dialysis. These patients have impaired physical growth, high number of comorbidities and great need for continuous attention of specialized services with high demand for complex and costly procedures. OBJECTIVE: The aim of this study was to estimate the incidence and prevalence rates and describe the characteristics of children and adolescents undergoing chronic dialysis treatment in a Brazilian demographic health survey. MATERIALS AND METHODS: A cross-sectional study was performed in a representative sample of dialysis centers (nc = 239) that was established from the 2011 Brazilian Nephrology Society Census (Nc = 708). We collected data encompassing the five Brazilian macro-regions. We analyzed the data from all patients under 19 years of age. The sample population consisted of 643 children and adolescents who were on chronic dialysis program anytime in 2012. Data collection was carried out in the dialysis services by means of patients' records reviews and personal interviews with the centers' leaders. RESULTS: We estimated that there were a total of 1,283 pediatric patients on chronic dialysis treatment in Brazil, resulting in a prevalence of 20.0 cases per million age-related population (pmarp) (95% CI: 14.8-25.3) and an incidence of 6.6 cases pmarp in 2012 (95% CI: 4.8-8.4). The South region had the highest prevalence and incidence rates of patients under dialysis therapy, 27.7 (95% CI: 7.3-48.1) and 11.0 (95% CI: 2.8-19.3) cases pmarp, respectively; the lowest prevalence and incidence rates were found in the North-Midwest region, 13.8 (95% CI: 6.2-21.4), and in the Northeast region, 3.8 (95% CI: 1.4-6.3) cases pmarp, respectively. CONCLUSION: Brazil has an overall low prevalence of children on chronic dialysis treatment, figuring near the rates from others countries with same socioeconomic profile. There are substantial differences among regions related to pediatric chronic dialysis treatment. Joint strategies aiming to reduce inequities and improving access to treatment and adequacy of services across the Brazilian regions are necessary to provide an appropriate care setting for this population group.

The Brazilian collaborative registry for pediatric renal transplantation began in 2004 as a multicenter initiative aimed at analyzing, reporting, and disseminating the results of pediatric renal transplantation in Brazil. Data from all pediatric renal transplants performed from January 2004 to May 2018 at the 13 participating centers were analyzed. A total of 2744 pediatric renal transplants were performed in the thirteen participating centers. The median age at transplantation was 12.2 years, with the majority being male recipients (56%). The main underlying diseases were CAKUT (40.5%) and glomerulopathy (28%). 1981 (72%) of the grafts were from deceased donors (DD). Graft survival at one year (censored by death) was 94% in the live donor group (LD) and 91% in the DD group (log-rank test P < 0.01). The patient's survival at one and 5 years was 97% and 95% for the LD group and 96% and 93% for the DD group (log-rank test P = 0.02). The graft loss rate was 19% (n = 517), more frequently caused by vascular thrombosis (n = 102) and chronic graft nephropathy (n = 90). DD recipients had 1.6 (1.0-2.2) times greater chance of death and 1.5 (1.2-1.8) times greater chance of graft loss compared to LD recipients. The mortality rate was 5.4% (n = 148), mainly due to infection (n = 69) and cardiovascular disease (n = 28). The results of this collaborative pediatric renal transplant record are comparable to other international registries, although we still have a high infection rate as a cause of death.

Abstract Objectives: this study aimed to assess the quality of life and the relationship between the sleep of parents and primary caregivers of children under two years old. Methods: a cross-sectional study was conducted with parents, mothers, or caregivers of infants aged one to 23 months, using online administration of the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality and the WHOQOL-BREF to assess quality of life. Results: the vast majority of the 456 respondents were mothers (97.6%) and primary caregivers of the child (97.6%). Among the participants, 76.5% reported having a good or very good quality of life, which was not influenced by the age of the child. The vast majority (83.4%) of respondents had a PSQI score above 5, indicating poor sleep quality. Sleep quality showed a significant negative correlation with most domains of the WHOQOL-BREF. Conclusions: mothers of children under two years old experience poor sleep quality, which negatively impacts their quality of life. Healthcare professionals should pay special attention to the physical and mental health of caregivers of young children, and public policies related to parental leave rights and labor rights should take such results into account.

Resumo Objetivos: avaliar a qualidade de vida e a relação existente entre o sono de pais e principais cuidadores de crianças menores de dois anos. Métodos: estudo transversal realizado com pais, mães ou cuidadores de lactentes de um a 23 meses de vida, com aplicação online dos questionários Pittsburgh Sleep Quality Index, para avaliação da qualidade do sono, e WHOQOL-BREF, para qualidade de vida. Resultados: a maior parte dos 456 respondedores eram mães (97,4%) e principais cuidadores da criança (97,6%). Dentre os participantes, 76,5% referiram ter uma qualidade de vida boa ou muito boa, o que não teve impacto com a idade da criança. A grande maioria (83,4%) dos respondedores teve uma pontuação no PSQI &gt;5, indicando qualidade do sono ruim. A qualidade do sono teve correlação negativa e significativa com a maioria dos domínios do WHOQOL-BREF. Conclusões: mães de crianças com menos de dois anos apresentam baixa qualidade do sono, o que impacta negativamente em sua qualidade de vida. Profissionais da saúde devem ficar especialmente atentos à saúde física e mental dos cuidadores de crianças pequenas, e as políticas públicas relacionadas aos direitos de licença maternidade e paternidade e direitos trabalhistas devem levar tais resultados em consideração.