RESUMEN
Dialysis adequacy (Kt/V) was investigated in two groups of patients on continuous ambulatory peritoneal dialysis (CAPD). Group I consisted of patients with serum creatinine concentration above 1200 mumol/l and Group II comprised patients with serum creatinine concentration of 600 mumol/l and less. The mean Kt/V was significantly higher in Group II (Kt/V, 2.0) than in Group I (Kt/V, 1.59; p < 0.01) patients. The mean duration of CAPD was significantly longer in Group I (3.12 years) than in Group II (1.32 years; (p < 0.01) patients, and the mean total creatinine clearance for Group II patients was significantly higher than for Group I (p < 0.001) patients. There was good correlation between Kt/V and total creatinine clearance (r = 0.73; p < 0.001); and between Kt/V and normalized protein catabolic rate (NPCR, r = 0.6; p < 0.001). There was weak correlation between Kt/V and duration on dialysis, but this was statistically significant. There was no significant difference between mean NPCR and mean mid-arm muscle circumference (MAMC) in the two groups and no significant association between Kt/V and dietary inventory. Group II patients had a significantly better residual renal clearance (p < 0.0001). Pruritus was a troublesome feature in Group I patients but in both groups patients were distressed by loss of libido, insomnia and tiredness. This study revealed that Group II patients with lower creatinine concentrations had better dialysis adequacy but were on CAPD for a shorter duration than Group I and had significantly better residual renal clearance and total clearance. Muscle mass does not appear to have contributed significantly to the differences in creatinine concentration between the groups. Additional studies on peritoneal membrane function vis-à-vis solute transfer are in progress.
Asunto(s)
Nitrógeno de la Urea Sanguínea , Fallo Renal Crónico/terapia , Diálisis Peritoneal Ambulatoria Continua , Adulto , Índice de Masa Corporal , Creatinina/sangre , Femenino , Humanos , Fallo Renal Crónico/sangre , Pruebas de Función Renal , Cinética , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Dialysis adequacy (Kt/V) was investigated in two groups of patients on continuous ambulatory peritoneal dialysis (CAPD). Group I consisted of patients with serum creatinine concentration above 1200 umol/l and Group II comprised patients with serum creatinine concentration of 600 umol/l and less. The mean Kt/V was significantly higher in Group II (Kt/V, 2.0) than in Group I (Kt/V, 1.59; p < 0.01) patients. The mean duration of CAPD was significantly longer in Group I (3.12 years) than in Group II (1.32 years); (p < 0.01) patients, and the mean total creatinine clearance of Group II patients was significantly higher than for Group I (p < 0.001) patients. There was good correlation between Kt/V and total creatinine clearance (r = 0.73; p < 0.001); and between Kt/V and normalized protein catabolic rate (NPCR, r = 0.6; p < 0.001). There was weak correlation between Kt/V and duration on dialysis, but this was statistically significant. There was no significant difference between Kt/V and duration on dialysis, but this was statistically significant. There was no significant difference between mean NPCR and mean mid-arm muscle circumference (MAMC) in the two groups and no significant association between Kt/V and dietary inventory. Group II patients had a significantly better residual renal clearance (p < 0.0001). Pruritus was a troublesome feature in Group I patients but in both groups patients were distressed by loss of libido, insomnia and tiredness. This study revealed that Group II patients with lower creatinine concentrations had better dialysis adequacy but were on CAPD for a shorter duration than Group I and had significantly better residual renal clearance and total clearance. Muscle mass does not appear to have contributed significantly to the differences in creatinine concentration between the groups. Additional studies on peritoneal membrane function vis-a-vis solute transfer are in progress.(AU)
Asunto(s)
Adulto , Estudio Comparativo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Urea/metabolismo , Diálisis Peritoneal Ambulatoria Continua , Creatinina/sangre , Modelos Biológicos , CinéticaRESUMEN
Dialysis adequacy (Kt/V) was investigated in two groups of patients on continuous ambulatory peritoneal dialysis (CAPD). Group I consisted of patients with serum creatinine concentration above 1200 umol/l and Group II comprised patients with serum creatinine concentration of 600 umol/l and less. The mean Kt/V was significantly higher in Group II (Kt/V, 2.0) than in Group I (Kt/V, 1.59; p < 0.01) patients. The mean duration of CAPD was significantly longer in Group I (3.12 years) than in Group II (1.32 years); (p < 0.01) patients, and the mean total creatinine clearance of Group II patients was significantly higher than for Group I (p < 0.001) patients. There was good correlation between Kt/V and total creatinine clearance (r = 0.73; p < 0.001); and between Kt/V and normalized protein catabolic rate (NPCR, r = 0.6; p < 0.001). There was weak correlation between Kt/V and duration on dialysis, but this was statistically significant. There was no significant difference between Kt/V and duration on dialysis, but this was statistically significant. There was no significant difference between mean NPCR and mean mid-arm muscle circumference (MAMC) in the two groups and no significant association between Kt/V and dietary inventory. Group II patients had a significantly better residual renal clearance (p < 0.0001). Pruritus was a troublesome feature in Group I patients but in both groups patients were distressed by loss of libido, insomnia and tiredness. This study revealed that Group II patients with lower creatinine concentrations had better dialysis adequacy but were on CAPD for a shorter duration than Group I and had significantly better residual renal clearance and total clearance. Muscle mass does not appear to have contributed significantly to the differences in creatinine concentration between the groups. Additional studies on peritoneal membrane function vis-a-vis solute transfer are in progress.
Asunto(s)
Adulto , Femenino , Humanos , Persona de Mediana Edad , Urea/metabolismo , Diálisis Peritoneal Ambulatoria Continua , Creatinina/sangre , Cinética , Modelos BiológicosRESUMEN
Seventy ward referrals for renal disease were prospectively studied at each of two tertiary hospitals: University Hospital of the West Indies (UHWI), Kingston, Jamaica and Nottingham City Hospital (NCH), England. At UHWI, the referral population was significantly younger, 89% being less than 60 years of age compared to 40% at NCH (p < 0.05). The leading cause of acute renal failure (ARF) at UHWI was systemic lupus erythematosus (SLE) followed by acute tubular necrosis (ATN). The leading causes of ARF at NCH were ATN and obstructive uropathy. Primary renal disease and diabetes mellitus were the major causes of end-stage renal disease (ESRD) at both centres, followed by SLE and hypertension at UHWI and renovascular disease and chronic pyelonephritis at NCH. Nephrotic syndrome occurred more frequently at UHWI than at NCH but the numbers were small (p < 0.05). Mortality rates were similar among patients with ARF and nephrotic syndrome at both centres, but were higher for patients with chronic renal failure (CRF) at UHWI than at NCH (p < 0.05). Continuous ambulatory peritoneal dialysis (CAPD) was a frequent mode of renal replacement therapy at NCH (76% v 19% on haemodialysis). At UHWI, CAPD was not available and 45% of patients with ESRD were not offered maintenance dialysis because of inadequate facilities. The major difference in management and outcome between the two centres occurred in cases with CRF, suggesting that survival in patients with CRF in Jamaica could be improved if this therapeutic modality was available.
Asunto(s)
Fallo Renal Crónico/terapia , Adulto , Anciano , Diabetes Mellitus , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome Nefrótico , Diálisis Peritoneal Ambulatoria Continua , Estudios Prospectivos , Derivación y Consulta , Diálisis Renal , Terapia de Reemplazo RenalRESUMEN
Seventy ward referrals for renal disease were prospectively studied at each of two tertiary hospitals: University Hospital of the West Indies (UHWI), Kingston, Jamaica and Nottingham City Hospital (NCH), England. At UHWI, the referral population was significantly younger, 89 percent being less than 60 years of age compared to 40 percent at NCH (p<0.05). The leading cause of acute renal failure (ARF) at UHWI was systemic lupus erythematosus (SLE) followed by acute tubular necrosis (ATN). The leading causes of ARF at NCH were ATN and obstructive uropathy. Primary renal disease and diabetes mellitus were the major causes of end-stage renal disease (ESRD) at both centres, followed by SLE and hypertension at UHWI than at NCH but the numbers were small (p<0.05). Mortality rates were similar among patients with ARF and nephrotic syndrome at both centres, but were higher for patients with chronic renal failure (CRF) at UHWI than at NCH (p<0.05). Continuous ambulatory peritoneal dialysis (CAPD) was a frequent mode of renal replacement therapy at NCH (76 percent v 19 percent on haemodialysis). At UHWI, CAPD was not available and 45 percent of patients with ESRD were not offered maintenance dialysis because of inadequate facilities. The major difference in management and outcome between the two centres occurred in cases with CRF, suggesting that survival in patients with CRF in Jamaica could be improved if this therapeutic modality was available. (AU)
Asunto(s)
Humanos , Adulto , Anciano , Femenino , Masculino , Derivación y Consulta , Enfermedades Renales/epidemiología , Jamaica , Reino Unido , Factores de Edad , Factores SexualesRESUMEN
Seventy ward referrals for renal disease were prospectively studied at each of two tertiary hospitals: University Hospital of the West Indies (UHWI), Kingston, Jamaica and Nottingham City Hospital (NCH), England. At UHWI, the referral population was significantly younger, 89 percent being less than 60 years of age compared to 40 percent at NCH (p<0.05). The leading cause of acute renal failure (ARF) at UHWI was systemic lupus erythematosus (SLE) followed by acute tubular necrosis (ATN). The leading causes of ARF at NCH were ATN and obstructive uropathy. Primary renal disease and diabetes mellitus were the major causes of end-stage renal disease (ESRD) at both centres, followed by SLE and hypertension at UHWI than at NCH but the numbers were small (p<0.05). Mortality rates were similar among patients with ARF and nephrotic syndrome at both centres, but were higher for patients with chronic renal failure (CRF) at UHWI than at NCH (p<0.05). Continuous ambulatory peritoneal dialysis (CAPD) was a frequent mode of renal replacement therapy at NCH (76 percent v 19 percent on haemodialysis). At UHWI, CAPD was not available and 45 percent of patients with ESRD were not offered maintenance dialysis because of inadequate facilities. The major difference in management and outcome between the two centres occurred in cases with CRF, suggesting that survival in patients with CRF in Jamaica could be improved if this therapeutic modality was available.
Asunto(s)
Humanos , Adulto , Anciano , Femenino , Derivación y Consulta , Enfermedades Renales/epidemiología , Factores Sexuales , Factores de Edad , Reino Unido , JamaicaRESUMEN
Three case reports of Cytomegalovirus (CMV) disease in seronegative renal transplant recipients of seropositive donor kidneys are presented. Clinicians need to have a high index of suspicion for CMV disease in such patients. Early diagnosis and treatment are essential to decrease morbidity and mortality. Prophylaxis with antiviral and/or CMV-hyperimmunoglobulin may decrease the incidence of serious infection.
Asunto(s)
Infección Hospitalaria/transmisión , Infecciones por Citomegalovirus/transmisión , Trasplante de Riñón/efectos adversos , Adolescente , Adulto , Infección Hospitalaria/sangre , Infección Hospitalaria/tratamiento farmacológico , Infecciones por Citomegalovirus/sangre , Infecciones por Citomegalovirus/tratamiento farmacológico , Diagnóstico Diferencial , Femenino , Ganciclovir/uso terapéutico , Humanos , MasculinoRESUMEN
Three case reports of cytomegalovirus (CMV) disease in seronegative renal transplant recipients of seropositive donor kidneys are presented. Clinicians need to have a high index of suspicion for CMV disease in such patients. Early diagnosis and treatment are essential to decrease morbidity and mortalitiy. Prophylaxis with antiviral and/or CMV-hyperimmunoglobulin may decrease the incidence of serious infection (AU)
Asunto(s)
Informes de Casos , Humanos , Masculino , Femenino , Adolescente , Adulto , Trasplante de Riñón/efectos adversos , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/tratamiento farmacológico , Terapia de Inmunosupresión/efectos adversos , Rechazo de InjertoRESUMEN
Three case reports of cytomegalovirus (CMV) disease in seronegative renal transplant recipients of seropossitive donor kidneys are presented. Clinicians need to have a high index of suspicion for CMV disease in such patients. Early diagnosis and treatment are essential to decrease morbidity and mortalitiy. Prophylaxis with antiviral and/or CMV-hyperimmunoglobulin may decrease the incidence of serious infection
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Trasplante de Riñón/efectos adversos , Infecciones por Citomegalovirus/complicaciones , Terapia de Inmunosupresión/efectos adversos , Infecciones por Citomegalovirus/tratamiento farmacológico , Rechazo de InjertoRESUMEN
Dialysis adequacy (Kt/V) was investigated in two groups of patients on continuous ambulatory peritoneal dialysis (CAPD). Group I consisted of patients with serum creatinine 1200 umol/1 and above and Group II comprised patients with serum creatinine 600 umol/1 and less. The mean Kt/V was significantly higher in Group II (Kt/V, 2.0) compared to Group I (Kt/V, 1.59; p <0.01). The mean duration of CAPD dialysis was significantly longer in Group I (3.12 years) compared to Group II (1.32 years; p <0.01). Also, the mean total creatinine clearance for Group II was significantly higher than for Group I (p <0.001). There was good correlation between Kt/V and total creatinine clearance (r = 0.73; p <0.001); Kt/V and normalized protein catabolic rate (NPCR, r=0.6; p <0.001). There was weak correlation between Kt/V and duration on dialysis, but this was statistically significant. There was no difference between mean NPCR and mean mid-arm muscle circumference (MAMC) in the two groups and no significant association between Kt/V and NAMC. Group II patients had a significantly better residual renal clearance (p <0.0001). Pruritus was a troublesome feature in Group I, but in both groups patients were distressed by loss of libido, insomnia and tiredness. This study revealed that Group II patients with lower creatinine had better dialysis adequacy but were on CAPD for a shorter duration than Group I and had significantly better residual renal clearance and total clearance. Muscle mass does not appear to have contributed significantly to the differences in creatinine between the groups. Additional studies on peritoneal membrane function vis-a-vis solute transfer need to be done on these patients (AU)