Background The remarkably efficient mechanisms of the human body to maintain its core temperature of 37°C can be inadequate when harsh climatic conditions and excessive muscle movement lead to heat stress, dehydration and potential heat illness, ranging from minor symptoms such as fatigue to a potentially fatal heat stroke. Agricultural workers in the tropics are at high risk, which is expected to increase with climate change. Sugarcane harvesting in Costa Rica is largely done by cutting the cane with a machete, by temporary, sub-contracted workers who are often migrants and living in poverty. Sugarcane harvesters are known to be affected by an epidemic of chronic kidney disease of non-traditional origin, currently hypothesized to be related to working conditions. Objectives This work aimed to better understand and document sugarcane harvester exposure to heat and the health consequences of working under such conditions. Specific objectives were to 1) Document working conditions and heat in the Costa Rican sugarcane industry (Paper I); 2) Quantify heat stress exposures faced by sugarcane harvesters in Costa Rica (Paper II); and 3) Quantify the occurrence of heat stress symptoms and abnormal urinary parameters in sugarcane workers in Costa Rica (Papers III and IV). Methods This study took place over three harvests following a pilot assessment prior to the first harvest. Methods included direct observation, semi-structured interviews with 24 individuals and a participatory workshop with 8 harvesters about heat-related perceptions, exposures and coping strategies during the harvest and non-harvest season (Pilot). Researchers accompanied workers in the field during all three harvests, measured wet bulb globe temperature (WBGT) and conducted direct observation. Heat exposure assessment was conducted by calculating metabolic load, WBGT and corresponding limit values based on international guidelines (NTP and OSHA) (Harvest 1). Self-reported symptom data were collected using orally-administered questionnaires from 106 sugarcane harvesters and 63 non-harvesters from the same company (Harvest 2). Chi-square test and gamma statistic were used to evaluate differences in self-reported symptoms and trends over heat exposure categories. Finally, liquid consumption during the work shift was documented and urinalysis was conducted pre-and post-shift in 48 sugarcane harvesters on three days; differences were assessed with McNemar´s test on paired proportions (Harvest 3). Results Sugarcane workers in both the harvest and non-harvest seasons are exposed to heat, but particularly during the harvest season. Field workers have to carry their own water to the field and often have no access to shade. Some plantworkers are also exposed to intense heat. The metabolic load of sugarcane harvesting was determined to be 261 W/m2. The corresponding threshold value is 26 ◦C WBGT, above which workers should decrease work load or take breaks to avoid the risk of heat stress. Harvesters in this study were at risk of heat stress as early as 7:15 am on some mornings and by 9:00 am on all mornings. After 9:15 am, OSHA recommendations would require that harvesters only work at full effort 25% of each hour to avoid heat stress. Heat and dehydration symptoms at least once per week were experienced significantly more frequently among harvesters than non-harvesters (p<0.05): headache, tachycardia, fever, nausea, difficulty breathing, dizziness, and dysuria. Percentages of workers reporting heat and dehydration-related symptoms increased over increasing heat exposure categories. Total liquid consumed ranged from 1 to 9 L and differed over days (median 5.0, 4.0 and 3.25 on days 1, 2 and 3 respectively). On these same days, the two principle indicators of dehydration: high USG (≥1.025) and low pH (≤5), changed significantly from pre to post-shift (p=0.000 and p=0.012).Proportions of workers with proteinuria >30 mg/dL, and blood, leucocytes and casts in urine were also significantly different between pre and post-shift samples at the group level, but unlike USG and pH, these alterations were more frequent in the pre-shift sample. 85% of workers presented with proteinuria at least once and 52% had at least one post-shift USG indicative of dehydration. Conclusion Heat exposure is an important occupational health risk for sugarcane workers according to international standards. A large percentage of harvesters experience symptoms consistent with heat exhaustion throughout the harvest season. Pre and post-shift urine samples demonstrate dehydration and other abnormal findings. The results of this study demonstrate an urgent need to improve working conditions for sugarcane harvesters both under current conditions and in adaptation plans for future climate change.

Angiotensin II (AngII), the major effector of the renin angiotensin system, mediates kidney disease progression by signalling through AT-1 receptor (AT-1R), but there are no specific measures of renal AngII activity. Accordingly, we sought to define an AngII-regulated proteome in primary human proximal tubular cells (PTEC) in order to identify potential AngII activity markers in the kidney. We utilized stable isotope labelling with amino acids (SILAC) in PTECs to compare proteomes of AngII-treated and control cells. Of 4618 quantified proteins, 83 were differentially regulated. SILAC ratios for 18 candidates were confirmed by Selected Reaction Monitoring (SRM) assays. Both SILAC and SRM revealed the nuclear factor erythroid 2-related 2 (Nrf2) target protein, heme oxygenase-1 (HO-1) as the most significantly upregulated protein in response to AngII stimulation. AngII-dependent regulation of HO-1 gene and protein was further verified by qRT-PCR and ELISA in PTECs. In order to extend these in vitro observations, we utilized a systems biology approach. We thus overlaid a network of significantly enriched gene ontology (GO) terms from our AngII-regulated proteins with a dataset of differentially expressed kidney genes from AngII-treated wild type mice and AT-1R knock-out mice. Five GO terms were enriched both in vitro and in vivo, and all included HO-1. Furthermore, four additional Nrf2 target proteins were functionally important in vitro and in vivo. We then studied HO-1 kidney expression and urinary excretion in AngII-treated wild type mice and mice with PTEC-specific AT-1R gene deletion. Deletion of the AT-1R gene in PTECs lowered both kidney expression and urine excretion of HO-1, confirming AngII/AT-1R mediated regulation of HO-1. In summary, our in vitro experiments identified novel molecular markers of AngII activity in PTECs and the animal studies demonstrated that these markers also reflect AngII activity in PTECs in vivo. These interesting proteins hold promise as specific markers of renal AngII activity in patients and in experimental models.

Chronic kidney disease (CKD) is frequently described as a chronic illness. It is also a life-threatening illness, although this is rarely discussed. When people with CKD face declining kidney function, they need technological assistance to extend life. Many people receiving treatment will also die within 5 years. The experience of living with CKD is often difficult to articulate, and little is known about the aspects of this illness that are often ineffable, difficult to discuss, or beyond words. The purpose of this dissertation is to present four papers in which I investigate the concept of the unsayable and illuminate how this concept may be helpful in exploring individuals’ stories of living with CKD. Located in social constructionism, this narrative research explores the unsayable aspects of experience for people living with CKD as portrayed through their stories and symbols. In the first paper, I present a concept analysis of the unsayable and I define the unsayable as that which is not expressed yet alluded to through language and may be conscious or unconscious. Although the unsayable is intertwined with language, it also transcends articulation. In the second paper, I offer a qualitative meta-synthesis and I show how people with kidney failure have experienced restricted freedom that brings about distant connection, dependent autonomy, abnormal normalcy, and uncertain hope. In the third paper, I present a narrative inquiry using secondary analysis of 46 interviews conducted over 3 years with 14 people living with CKD. Narrative expressions of the unsayable include the following: living with death, embodied experiences that were difficult to language, that which was unthinkable, unknowable mystery, and that which was untold / unheard. Lastly, I offer a narrative visual analysis of symbols that represent living with CKD for 13 participants. Descriptive themes of the symbols include hopes and inspirations, reflections on “who I am,” and confrontations of illness. Participants’ expressions through symbols are described through stories of memories, emotions, and poetic devices. Consideration of the unsayable may offer insights for nurses who work to support individuals and promote quality of life for those living with this chronic and life-threatening illness. / Graduate

Elevated plasma total homocysteine (ptHcy) or hyperhomocysteinemia (hHcy) independently predicts cardiovascular disease in predialysis chronic kidney disease (pCKD). Folate status is one of the known nutritional determinants of ptHcy. In the era of folic acid food fortification, this cross-sectional study aimed to describe in pCKD subjects (n=48): 1) Prevalence of hHcy. 2) Intake and status of nutrients involved in homocysteine metabolism. 3) Determinants of ptHcy. The prevalence of hHcy was 93.8% (95% CI: 81.8 to 98.4). Median (25th, 75th percentile) total folate intake from food and supplements was 389 (282,640) µg DFE/d. No subject was folate deficient (red blood cell < 317 nmol/L). Red blood cell folate (r = - 0.406, p=0.004) and energy-protein undernutrition (r = 0.357, p=0.013) independently predicted ptHcy. To conclude, total folate intake among subjects with pCKD was sufficient to prevent folate deficiency but not able to prevent a high prevalence of hHcy.

Elevated plasma total homocysteine (ptHcy) or hyperhomocysteinemia (hHcy) independently predicts cardiovascular disease in predialysis chronic kidney disease (pCKD). Folate status is one of the known nutritional determinants of ptHcy. In the era of folic acid food fortification, this cross-sectional study aimed to describe in pCKD subjects (n=48): 1) Prevalence of hHcy. 2) Intake and status of nutrients involved in homocysteine metabolism. 3) Determinants of ptHcy. The prevalence of hHcy was 93.8% (95% CI: 81.8 to 98.4). Median (25th, 75th percentile) total folate intake from food and supplements was 389 (282,640) µg DFE/d. No subject was folate deficient (red blood cell < 317 nmol/L). Red blood cell folate (r = - 0.406, p=0.004) and energy-protein undernutrition (r = 0.357, p=0.013) independently predicted ptHcy. To conclude, total folate intake among subjects with pCKD was sufficient to prevent folate deficiency but not able to prevent a high prevalence of hHcy.

Orientador: Roberto Jorge da Silva Franco / Resumo: Introdução: A doença renal crônica (DRC) tem uma inter-relação complexa com outras doenças. A literatura relata a associação direta entre declínio da função renal e comprometimento cognitivo, o qual está relacionado com pior qualidade de vida (QV). Alterações na hemodinâmica cerebral podem desempenhar papel relevante na patogenia da disfunção cognitiva entre pacientes em hemodiálise (HD). Recentemente, surgiram evidências que apoiam o papel da atividade física na prevenção ou no adiamento do declínio cognitivo. Objetivo: Avaliar os efeitos do treinamento aeróbico intradialítico sobre o fluxo sanguíneo cerebral, função cognitiva e QV em pacientes com DRC que realizam HD. Casuística e Métodos: Estudo clínico controlado e randomizado de intervenção fisioterápica, com análise de intenção de tratar. Trinta pacientes foram submetidos a teste ergométrico, avaliação do fluxo sanguíneo cerebral, avaliação da rigidez arterial, teste de função cognitiva e questionário de QV. O grupo de intervenção (GI), com quinze pacientes, foi submetido a treinamento aeróbico intradialítico, três vezes por semana, durante quatro meses. O grupo controle (GC), com quinze pacientes, não teve intervenção. Todos os pacientes foram reavaliados após o término do protocolo de atividade física ou após quatro meses da primeira avaliação, para o grupo controle. Resultados: No GI, os resultados mostraram melhora estatisticamente significante da função cognitiva (p<0,001), velocidade máxima do fluxo sanguíneo da a... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Chronic kidney disease (CKD) has a complex interrelationship with other diseases. The literature reports a direct association between decline in kidney function and cognitive impairment, which is associated with worse quality of life (QoL). Changes in cerebral hemodynamics may play a role in the pathogenesis of cognitive impairment among patients on hemodialysis (HD). Recently, there is evidence to support the physical activity role in preventing or delaying cognitive decline. Objective: To evaluate the effects of intradialytic aerobic training on cerebral blood flow, cognitive function and QoL in patients with CKD in HD. Methods: randomized controlled trial of physiotherapy intervention, with analysis intention to treat. Thirty patients underwent exercise testing, evaluation of cerebral blood flow, arterial stiffness, cognitive function test and QoL questionnaire. Fifteen patients in intervention group (IG) underwent intradialytic aerobic exercise three times a week for four months. Others fifteen patients in control group (CG) had no intervention. All patients were reassessed after the physical activity protocol or four months after the first evoluation, for the control group. Results: In IG, results showed statistically significant improvement of cognitive function (p <0.001), maximum blood flow velocity of the basilar artery (p = 0.029) and QoL in the fields dialysis staff encouragement (p = 0.025) and pain (p = 0.008). The variable arterial stiffness was no... (Complete abstract click electronic access below) / Doutor

Introduction: Chronic kidney disease (CKD) and congestive heart failure (CHF) patients have higher serum B-type natriuretic peptide (BNP), which alters the test interpretation. We aim to define BNP cutoff levels to diagnose acute decompensated heart failure (ADHF) in CKD according to CHF subtype: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Material and methods: We reviewed 1,437 charts of consecutive patients who were admitted for dyspnea. We excluded patients with normal kidney function, without measured BNP, echocardiography, or history of CHF. BNP cutoff values to diagnose ADHF for CKD stages according to CHF subtype were obtained for the highest pair of sensitivity (Sn) and specificity (Sp). We calculated positive and negative likelihood ratios (LR+ and LR–, respectively), and diagnostic odds ratios (DOR), as well as the area under the receiver operating characteristic curves (AUC) for BNP. Results: We evaluated a cohort of 348 consecutive patients: 152 had ADHF, and 196 had stable CHF. In those with HFpEF with CKD stages 3–4, BNP < 155 pg/ml rules out ADHF (Sn90%, LR– = 0.26 and DOR = 5.75), and BNP > 670 pg/ml rules in ADHF (Sp90%, LR+ = 4 and DOR = 6), with an AUC = 0.79 (95% CI: 0.71–0.87). In contrast, in those with HFrEF with CKD stages 3–4, BNP < 412.5 pg/ml rules out ADHF (Sn90%, LR– = 0.19 and DOR = 9.37), and BNP > 1166.5 pg/ml rules in ADHF (Sp87%, LR+ = 3.9 and DOR = 6.97) with an AUC = 0.78 (95% CI: 0.69–0.86). All LRs and DOR were statistically significant. Conclusions: BNP cutoff values for the diagnosis of ADHF in HFrEF were higher than those in HFpEF across CKD stages 3–4, with moderate discriminatory diagnostic ability. / Revisión por pares

Organisms are continuously exposed to heterogeneous micro- and macro-parasitic species, hence simultaneous infections often occur in wild and farm environments. This joint project aimed to develop a co-infection model between chronic and acute infections, evaluating their impact on the fish immune system. Proliferative Kidney Disease was studied on farmed rainbow and brown trout during natural seasonal outbreaks, using a parasite gene (Tetracapsuloides bryosalmonae RPL18) as a proxy for assessment of parasite burden. In hosts with elevated susceptibility PKD pathogenesis was shaped by an anti-inflammatory phenotype, a profound B cell/antibody response and dysregulated TH cell-like activity. Pathogen-free brown trout were exposed to Viral Haemorrhagic Septicaemia Virus (comparatively using European VHSV-Ia and North American VHSV-IVb strains) or to the bacterium Yersinia ruckeri. This European native species was highly resistant to the VHSV-IVb strain, which was undetectable in internal organs despite raising a strong antiviral and mucosal immune response. Following VHS and Yersiniosis infection, haemo-lymphopoietic organs were screened by RT-qPCR to assess the specific pathogen burdens and characterise the immune responses elicited. Transcription patterns were analysed for Interferons, CXC chemokines, SOCS (potential disease resistance biomarkers) and genes of the PACAP system. Lastly, PKD-infected brown trout were co-infected with VHSV-Ia, resulting in typical lesions while showing reduced and delayed mortality. PKD+/VHS+ fish were identified by RT-qPCR and histopathology screening. Pro-inflammatory and antimicrobial peptide genes were modulated following virus co-infection when compared to fish with single infection, with an earlier activation of cellular and humoral responses, and a stronger up-regulation of TH1 and antiviral genes. Oligonucleotide microarrays were used to assess the broader immune gene transcription modulation between single- and co-infected fish. Overall, the results suggest that the immune response of brown trout might be enhanced during the PKD/VHS co-infection.

Made available in DSpace on 2015-07-22T20:50:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-22 / Considerando a elevada prevalência de hipovitaminose D em pacientes na fase não dialítica da doença renal crônica (DRC) e os efeitos benéficos da restauração do estado nutricional de vitamina D nos pacientes com DRC nos parâmetros do metabolismo mineral, os guias de práticas clínicas para prevenção e tratamento dos distúrbios do metabolismo mineral ósseo, Kidney Disease Outcomes Quality Initiative (K-DOQI) e Kidney Disease Improving Global Outcomes (KDIGO), sugerem a suplementação com vitamina D (ergocalciferol ou colecalciferol) para pacientes com DRC na fase não dialítica com hipovitaminose D. No entanto, poucos estudos avaliaram o efeito da suplementação nessa população. Dessa forma, este estudo tem como objetivo investigar os efeitos da suplementação com colecalciferol sobre marcadores séricos do metabolismo mineral de pacientes com hipovitaminose D na fase não dialítica da DRC. Estudo 1. Suplementacao com colecalciferol na doenca renal cronica: restauracao do estado nutricional de vitamina D e impacto sobre o paratormonio. O estudo foi prospectivo com duracao de 6 meses. Foram incluidos 45 pacientes com deficiencia de vitamina D 25-hidroxivitamina D [25(OH)D] < 15 ng/mL. Os pacientes foram suplementados com 50.000 UI/semana de colecalciferol durante 3 meses, sendo que naqueles que alcancaram niveis de 25(OH)D„d 30 ng/mL a dose foi modificada para 50.000 UI/mes durante os proximos 3 meses. Para os demais pacientes, a mesma dose inicial foi mantida por mais 3 meses. Apos o inicio da suplementacao observou-se um aumento significativo nos niveis de 25(OH)D no tempo 3 e no tempo 6. Nos primeiros 3 meses de suplementacao, 78% dos pacientes atingiram niveis de 25(OH)D„d 30 ng/mL. No entanto, apos o ajuste da dose, somente 43% mantiveram esses niveis. Houve uma diminuicao nos niveis de paratormonio (PTH) no tempo 3, periodo em que os pacientes receberam a maior dose de colecalciferol. As mudancas nos niveis de 25(OH)D durante os 3 meses correlacionaram-se positivamente com as mudancas dos niveis de 1,25-diidroxivitamina D [1,25(OH)2D] (r= 0,37; P= 0,01). As variacoes nos niveis de PTH correlacionaram-se inversamente com as mudancas nos niveis de calcio serico (r= -0,42; P= 0,004) e diretamente com as mudancas na creatinina serica (r= 0,38; P= 0,01). A analise de regressao logistica incluindo a proteinuria do inicio do estudo e as mudancas nos niveis sericos de creatinina, demonstrou que o excesso de adiposidade foi o principal fator associado com uma menor resposta a suplementacao nos primeiros 3 meses (IMC „d 25 kg/m2: ƒÒ= 2,35, EP= 1,15, P= 0,04; indice de gordura do tronco: ƒÒ= 2,59, EP= 1,13, P= 0,02). Este estudo concluiu que o tratamento com 50.000 UI por semana de colecalciferol foi efetivo em restaurar o estado nutricional de vitamina D na maioria dos pacientes sem apresentar efeitos adversos. A restauracao dos niveis de vitamina D resultou na diminuicao do PTH mesmo com uma reducao da funcao renal. Estudo 2. Suplementacao com colecalciferol em pacientes com doenca renal cronica e insuficiencia de vitamina D. O estudo foi prospectivo com duracao de 6 meses, randomizado e cego. Foram incluidos 75 pacientes com insuficiencia de vitamina D [25(OH) D „d 15 e < 30 ng/mL. Os pacientes foram tratados de acordo com a recomendacao de suplementacao proposta pelo K-DOQI para pacientes com insuficiencia de vitamina D (50.000 UI de colecalciferol mensalmente durante 6 meses). Os mesmos foram aleatoriamente alocados em dois grupos: Grupo Colecalciferol (n= 38 pacientes) ou Grupo Placebo (n= 37 pacientes). O grupo colecalciferol recebeu durante todo periodo de estudo 50.000 UI de colecalciferol mensalmente. Todos os pacientes incluidos no estudo receberam protetor solar durante o periodo de suplementacao. Apos o periodo de suplementacao houve um aumento significativo nos niveis de 25(OH)D no grupo colecalciferol. Com relacao aos demais parametros do metabolismo mineral, nao foram observados modificacoes em nenhum dos parametros durante o seguimento. Apos 6 meses de suplementacao, 46% dos pacientes tratados nao atingiram niveis de 25(OH)D > 30 ng/mL. Esses pacientes apresentaram uma maior quantidade de gordura corporal quando comparados com aqueles que alcancaram esses niveis. Ja no grupo placebo, 40,5% dos pacientes atingiram niveis de 25(OH)D > 30 ng/mL no tempo 6. A epoca da coleta (verao/outono) para a determinacao dos niveis de 25(OH)D no tempo 6 foi o unico parametro que diferiu dos demais pacientes que mantiveram os niveis de 25(OH)D< 30 ng/mL. Em resumo, os resultados do presente estudo demonstram que o protocolo de tratamento proposto pelo K-DOQI parece nao ser adequado para restaurar o estado nutricional de vitamina D em pacientes com insuficiencia desta vitamina. No entanto, a gordura corporal e a epoca da coleta sao fatores que podem ter contribuido para o achado negativo deste estudo. / Background: The effective protocol for treatment of hypovitaminosis D in non-dialysis dependent chronic kidney disease (NDD-CKD) patients has not yet been defined. In the present study we aimed to investigate the impact of cholecalciferol supplementation on serum markers of bone and mineral metabolism using the K/DOQI recommendation for NDD-CKD patients with vitamin D insufficiency. Methods: This was a prospective, randomized, single-blinded interventional study with 6 month of follow-up. This study included 75 patients, randomly assigned for the cholecalciferol group (n=38; 50,000 IU per month for 6 months) or for the placebo group (n=37). Results: After cholecalciferol supplementation, 25(OH)D levels increased significantly at 3 and 6 months in the intervention group and was maintained in the placebo group. No change was found in serum parathyroid hormone as well as in the other serum markers of mineral metabolism studied during the follow-up in both groups. In the end of the study, 46% of the treated patients did not achieve 25(OH)D levels higher than 30 ng/mL. This group of patients had a greater body fat index when compared with those who achieved this level. In the placebo group 40.5% increased 25(OH)D levels higher than 30 ng/mL after 6 months. The season (summer/autumn) when blood was collected for 25(OH)D determination was the only parameter that differed from the group of patients who maintained 25(OH)D levels below 30 ng/mL. Conclusion: Our results indicate that the protocol for treatment of vitamin D insufficiency proposed by the K/DOQI guideline seems not to be adequate for completely restore the vitamin D status of NDD-CKD patients. The lack of adequate response to cholecalciferol supplementation together with the unpredicted restoration of vitamin D status in the placebo group may account, at least in part, for the negative results of the present study. / TEDE

Alterações gastrointestinais em pacientes com doença renal crônica são queixas comuns, sendo a constipação considerada um dos sintomas mais prevalentes. O tratamento deste sintoma é limitado nesta população, devido às modificações dietéticas impostas pela perda da função renal e métodos dialíticos, especialmente na hemodiálise. Dados locais sobre a prevalência e fatores associados à constipação são pouco conhecidos em nosso meio. Neste estudo transversal, foram incluídos 57 participantes que realizam hemodiálise há pelo menos 3 meses no Hospital Moinhos de Vento em Porto Alegre, Brasil. Um questionário foi utilizado para avaliar dados sociodemográficos e clínicos potencialmente associados à constipação, a qual foi definida utilizando os critérios de ROMA III. Foi diagnosticada constipação em 28 pacientes nesta amostra (49,1%). Do total da amostra, 34 indivíduos (59,6%) relataram estar utilizando ou já terem utilizado laxantes em algum momento. Entre os constipados, 23 (82%) relataram esse uso. Outros 11 indivíduos usam laxativos cronicamente, ainda que não tenham sido classificados como constipados pelos critérios de ROMA III. Considerando a autopercepção, relataram “dificuldade para evacuar” 21/57 (36,8%). A concordância entre a autopercepção de “dificuldade para evacuar” e constipação pelos critérios de ROMA III ocorreu em 34 (59,6%) dos indivíduos. Entre os 28 pacientes constipados, 17 (77,3%) referem que sintomas gastrointestinais interferem no seu bem-estar, enquanto que entre os 29 pacientes não constipados, somente 5 (22,7%) referem esta interferência (p = 0,01) Quando investigado os fatores potencialmente associados à constipação,a inatividade física (Razão de prevalência 53,4; Teste exato de Fisher p = 0,052) e o sexo feminino (Razão de Prevalência 1,6; Pearson X2 p = 0,07) apresentaram tendênciaà associação significativa. No entanto, não foi encontrada associação significativa entre constipação e escolaridade, faixa etária, utilização de carbonato de cálcio, presença de 8 diabetes, estado nutricional e consumo de fibras atual. Conclusões: A constipação intestinal é um sintoma frequente em pacientes em hemodiálise no nosso meio. A utilização dos critérios de ROMA III para o diagnóstico de constipação permite diagnosticar um maior número de casos quando comparado apenas à autopercepção. A maior parte dos pacientes da amostra faz ou já fez uso crônico de laxantes, ainda que boa parte destes não se considere constipado, ou seja, classificados como constipados pelos critérios de ROMA III. Considerando-se a alta prevalência e interferência no bem-estar, a abordagem sobre a presença de constipação deve ser rotineira nessa população, a fim de alcançar-se um diagnóstico e manejo corretos. / Seventeen (77.3%) of the 28 constipated patients reported that their gastrointestinal symptoms interfered with their wellbeing, whereas just 5 (22.7%) of the 29 patients without constipation reported the same interference (p = 0.01). Investigation of factors potentially associated with constipation detected that inactivity (Prevalence ratio 53.4; Fisher’s exact test p = 0.052) and female sex (Prevalence ratio 1.6; PearsonX2 p = 0.07) exhibited tendencies towards a significant association. However, there were no significant associations between constipation and educational level, age group, use of calcium carbonate, presence of diabetes, nutritional status, or current fiber consumption. 10 Conclusions: Constipation is a common symptom among patients on hemodialysis in our country. Use of the ROMA III criteria diagnoses a higher number of cases of constipation than patients’ own perception alone. The majority of patients in the sample have used or were still using laxatives chronically, even though a considerable proportion of these patients were not considered constipated,they were not classified as constipated according to the ROMA III criteria. Considering its high prevalence and its impact on wellbeing, whether patients have constipation should be routinely investigated in this population, to enable correct diagnosis and management.