RESUMEN
The aim of this study was to investigate the outcome of vascular access procedures for hemodialysis and factors affecting access survival and complication rates. A retrospective review was carried out on 276 patients who underwent 404 consecutive vascular access operations performed over seven-years. The overall primary failure rate was 9.2%, while the oneand five-year cumulative access patency rates were 63.8% and 40.6%, respectively. Diabetes mellitus status significantly influenced access survival (P = 0.022). Autogenous arteriovenous fistulas (AVFs) are reliable procedures with access sites often available in the upper limb proximally and distally. Patients with diabetes mellitus have significantly worse patency rates of upper limb AVFs.
Asunto(s)
Diálisis Renal , Dispositivos de Acceso Vascular , Adulto , Anciano , Derivación Arteriovenosa Quirúrgica/métodos , Nefropatías Diabéticas/fisiopatología , Nefropatías Diabéticas/terapia , Femenino , Humanos , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Extremidad Superior , Grado de Desobstrucción VascularRESUMEN
Hypertension is very common in kidney transplant patients; however, severe and resistant cases should raise suspicion of secondary causes. Pheochromocytomas are rare but serious tumors because of their lethal hypertensive and possible malignant nature. The diagnosis is occasionally elusive, but prompt diagnosis and localization is essential for definitive surgical management. We report a case of a patient with benign pheochromocytoma presenting largely asymptomatically, but with severe resistant hypertension, 6 years after kidney transplantation. To the best of our knowledge, this is the first case report of this type of tumor after kidney transplantation.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/etiología , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Feocromocitoma/etiología , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía , Antihipertensivos/uso terapéutico , Resistencia a Medicamentos , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/etiología , Feocromocitoma/diagnóstico , Feocromocitoma/cirugía , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVES: The primary goal of the present study was to implement and evaluate the impact of pharmaceutical care service for hospitalized chronic kidney disease (CKD) patients in Jordan. SETTING: Nephrology wards of one of the largest general hospitals in Jordan. METHODS: All patients who were previously diagnosed with CKD by their physician were eligible for inclusion in the study. Recruited patients were fully assessed for treatment related problems (TRPs) by a clinical pharmacist. Pharmaceutical care service was assessed through a systematic, prospective before-after design. Chi Square test was used to investigate association between categorical variables. P value <0.05 was considered to be statistically significant. MAIN OUTCOME MEASURES: Study outcomes included: Process outcomes (prevalence and nature of identified TRPs, clinical significance of TRPs, associated diseases and drugs), General clinical outcomes (Therapeutic outcomes of TRPs) and CKD specific clinical outcomes (Change from baseline in the number of patients receiving appropriate progression modifying therapy and appropriate management of complications). RESULTS: 130 patients were included in the study. The average number of the identified TRPs was 5.31. Eighty-six percent of the recommendations were accepted by physicians. Efficacy related problems were the most common TRP category. Seventeen percent of all TRPs were resolved, 5.5 % were improved, and 37.4 % were prevented through the clinical pharmacist interventions. CONCLUSIONS: The current study indicated that hospitalized patients with CKD suffer from multiple TRPs mostly related to efficacy of medications and patients monitoring. Clinical pharmacists substantially contributed towards the care of hospitalized CKD patients through optimizing progression modifying therapies, medications safety and management of CKD complications. Based on this study it is strongly recommended to implement pharmaceutical care services for hospitalized CKD patients.
Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Unidades de Hemodiálisis en Hospital , Educación del Paciente como Asunto , Farmacología Clínica/métodos , Servicio de Farmacia en Hospital/métodos , Medicina de Precisión , Insuficiencia Renal Crónica/tratamiento farmacológico , Adulto , Anciano , Terapia Combinada , Progresión de la Enfermedad , Monitoreo de Drogas , Femenino , Hospitales Generales , Humanos , Jordania , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Derivación y Consulta , Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/terapia , Índice de Severidad de la Enfermedad , Recursos HumanosRESUMEN
OBJECTIVES: The aim of this study was to identify the prevalence and characteristics of treatment related problems (TRPs) in hospitalized internal medicine patients in Jordan as well as to identify diseases and drugs associated with each specific TRP. We have also aimed at investigating physicians' acceptance of recommendations made by clinical pharmacist and to identify the outcomes of pharmacist interventions. SETTING: Internal medicine department of a general hospital in Jordan. METHODS: We have utilized a systematic, prospective, bedside, comprehensive clinical assessment approach that allowed us to effectively identify, communicate and follow up TRPs. MAIN OUTCOME MEASURES: prevalence and nature of identified TRPs, clinical significance of TRPs, associated diseases and drugs and clinical outcomes of clinical pharmacist interventions. RESULTS: 402 patients were included in the study. The average number of the identified TRPs was 9.35. Fifty-three percent of identified TRPs were classified as major and 28% were classified as moderate. Ninety-one percent of the recommendations were accepted by physicians. Efficacy related problems were the most common TRP category followed by safety related problems and indication related problems. Sixty-four percent of the TRPs were resolved or prevented through the clinical pharmacist intervention. CONCLUSIONS: We have found that prevalence of TRPs is substantially high among patients hospitalized at the internal medicine department. TRPs related to Dosage regimens, untreated conditions, patient monitoring, drug interactions, and drug choices were the most common. Most of TRPs identified by pharmacists were clinically significant. Pharmacists' interventions contributed substantially to the resolving of many of the identified TRPs. Patients suffering from higher number of medical conditions and receiving higher number of medications should be given the priority for clinical pharmacy service in hospitalized internal medicine patients.