RESUMEN
OBJECTIVE: Superior patient survival on continuous ambulatory peritoneal dialysis (CAPD) with 3 x 2-L exchanges has been reported from Hong Kong. This study examined the relationship between indices of dialysis adequacy and nutrition and patient survival on CAPD in Hong Kong. DESIGN: A cross-sectional study on prevalent CAPD patients. Patients were assessed for indices of dialysis adequacy and nutritional status with a composite nutritional index (CNI). Patients were then followed for 24 months. Survival data were analyzed according to adequacy indices and nutritional status. SETTING: All prevalent CAPD patients in nine dialysis centers in Hong Kong as of 1 April 1996. MAIN OUTCOME MEASURE: Mortality. RESULTS: 937 patients were assessed: 68.2% were using 3 x 2-L exchanges per day; mean age was 54.6 +/- 13 years. Mean total Kt/V was 1.83 +/- 0.42 and total creatinine clearance was 55.6 +/- 19.5 L/week/1.73 m2. 19% of patients were moderately to severely malnourished according to the CNI. There was no significant correlation between indices of adequacy and serum albumin or CNI. The 1- and 2-year patient survival from the time of assessment was 90.9% and 79.8%. There was a trend toward better survival in patients with Kt/V greater than 2.0, but it was not statistically significant. Peritoneal Kt/V did not impact survival in anuric patients. Malnourished patients had poorer survival than patients who were better nourished (p = 0.0259). After adjusting for age and diabetes, CNI was predictive of mortality but Kt/V and creatinine clearance were not. CONCLUSIONS: This study demonstrates the importance of nutritional status over adequacy indices in predicting patient survival. There was a lack of correlation between nutritional status and conventional indices of dialysis adequacy.
Asunto(s)
Creatinina/metabolismo , Fallo Renal Crónico/mortalidad , Estado Nutricional , Diálisis Peritoneal Ambulatoria Continua/mortalidad , Albúmina Sérica/metabolismo , Adulto , Anciano , Índice de Masa Corporal , Peso Corporal , Creatinina/orina , Estudios Transversales , Femenino , Estudios de Seguimiento , Hong Kong/epidemiología , Humanos , Fallo Renal Crónico/metabolismo , Fallo Renal Crónico/terapia , Tablas de Vida , Masculino , Persona de Mediana Edad , Diálisis Peritoneal Ambulatoria Continua/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
OBJECTIVE: To compare the therapeutic efficacy of daily oral levofloxacin plus intermittent intraperitoneal (IP) vancomycin (group 1) versus daily IP netromycin and intermittent IP vancomycin (group 2) in the primary treatment of peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD). DESIGN: A randomized multicenter prospective open-label comparative clinical study. SETTING: University and Hospital Authority hospitals in Hong Kong. PATIENTS: All CAPD patients who developed bacterial or culture-negative peritonitis beyond 28 days of a previous episode and without evidence of septicemia, associated tunnel infection, or known sensitivity to trial medications were accepted into the clinical trial. RESULTS: A total of 101 patients entered the trial. The primary cure rate was 74.5% for group 1 and 73.6% for group 2. Baseline culture results appeared to influence the clinical outcome: the primary cure rate for culture-negative, gram-positive, and gram-negative episodes was 83.3%, 78.6%, and 42.9% for group 1 and 69.1%, 76.9%, and 71.3% for group 2, respectively. The primary cure rate also varied considerably among individual centers and was particularly noticeable in group 1. In the latter group, it correlated closely with in vitro levofloxacin resistance which in turn correlated closely with previous exposure to fluoroquinolones. CONCLUSION: Oral levofloxacin in combination with intermittent IP vancomycin has comparable efficacy to IP netromycin combined with intermittent IP vancomycin as primary treatment in CAPD peritonitis, but is simpler and more cost-effective to administer. It may be recommended as primary therapy in centers with relatively low exposure and, therefore, low background resistance to fluoroquinolones.
Asunto(s)
Antibacterianos/uso terapéutico , Antiinfecciosos/uso terapéutico , Gentamicinas/uso terapéutico , Levofloxacino , Netilmicina/uso terapéutico , Ofloxacino/uso terapéutico , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/tratamiento farmacológico , Vancomicina/uso terapéutico , Administración Oral , Antibacterianos/administración & dosificación , Antiinfecciosos/administración & dosificación , Análisis Costo-Beneficio , Farmacorresistencia Microbiana , Femenino , Gentamicinas/administración & dosificación , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Inyecciones Intraperitoneales , Masculino , Persona de Mediana Edad , Netilmicina/administración & dosificación , Ofloxacino/administración & dosificación , Peritonitis/microbiología , Estudios Prospectivos , Inducción de Remisión , Resultado del Tratamiento , Vancomicina/administración & dosificaciónRESUMEN
We report on 352 cadaveric kidney transplants and 294 living related transplants performed over a 25-yr period among the Chinese population of Hong Kong. There is a marked preference for transplanting male patients, especially from living donors, and we argue that this represents a cultural phenomenon within the Chinese population. The 10-yr graft survivals for related and cadaveric transplants are 86.2% and 67.4%, respectively. These figures are appreciably higher than corresponding figures in Caucasian populations. We show beneficial effects of using cyclosporin A, minimizing the cold ischemia time and avoiding very young and very old donors. There is a clear benefit of transplanting kidneys with zero or one mismatched HLA antigen against the recipient but no stepwise decrease in outcome as the number of mismatched antigens increases. There is close concordance between the outcome of living related grafts with zero, one, and two mismatched haplotypes against the recipient and no observable benefit of haplotype matching. We show that Chinese renal transplant recipients in other centers also have better long-term graft outcome than Caucasians, both for cadaveric and living related transplants. We draw attention to the existence of a detrimental "race effect" in other studies when Black recipients are compared with Caucasians and consider whether an enhancing race effect exists for Chinese or whether the better outcome reflects different underlying diseases in Chinese.
Asunto(s)
Pueblo Asiatico , Trasplante de Riñón , Análisis Actuarial , Adolescente , Adulto , Factores de Edad , Población Negra , Cadáver , China/etnología , Criopreservación , Cultura , Ciclosporina/uso terapéutico , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Antígenos HLA/análisis , Haplotipos , Histocompatibilidad , Hong Kong/epidemiología , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Renales/fisiopatología , Trasplante de Riñón/estadística & datos numéricos , Donadores Vivos/estadística & datos numéricos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento , Población BlancaRESUMEN
Although the mortality rate from coronary artery disease in Hong Kong is only one-fourth of that of northern Europe and the United States, the disease has been and remains the second major cause of death (after all cancers combined). Beginning in 1987, we have conducted a case-control study of acute myocardial infarction in four Hong Kong hospitals. This study, one of the biggest case-control studies conducted in the Chinese population of both men and women, confirms the importance of several risk factors--cigarette smoking, history of hypertension, history of diabetes, body fatness, and lack of physical activity--previously described in data collected in western populations. In addition, more adverse childhood experience was also found to be an important risk factor of acute myocardial infarction. Further research in appropriate intervention measures in education in the prevention and cessation of smoking, the control of blood pressure, diabetes, and overweight, and adequate exercise could significantly help reduce the risk of acute myocardial infarction in the Hong Kong Chinese population.
Asunto(s)
Infarto del Miocardio/mortalidad , Vigilancia de la Población , Anciano , Anciano de 80 o más Años , Composición Corporal , Estudios de Casos y Controles , Causas de Muerte , China/etnología , Ejercicio Físico , Femenino , Hong Kong/epidemiología , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Obesidad/complicaciones , Obesidad/epidemiología , Obesidad/prevención & control , Prevalencia , Prevención Primaria , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Prevención del Hábito de Fumar , Factores SocioeconómicosRESUMEN
OBJECTIVE: To assess the importance of an abnormal lipid profile as a risk factor in relation to non-biochemical risk factors, and to define the risk levels for lipid, lipoprotein and apolipoprotein in a Chinese population. PATIENTS AND METHODS: Serum lipids, lipoproteins, apolipoproteins and other cardiovascular risk factors were studied in 89 Chinese men 3 months after acute myocardial infarction and 56 controls. RESULTS: Cases had higher mean total cholesterol (TC), LDL- and VLDL-cholesterol, triglycerides and apolipoprotein B (Apo B), and lower mean HDL-cholesterol and apolipoprotein AI (Apo AI). Mean BMI was also higher, as was the prevalence of smokers and subjects with a history of hypertension. In univariate analysis, the odds ratios for TG > or = 1.6 mmol/l, LDL-cholesterol > or = 4.1 mmol/l, VLDL-cholesterol > or = 0.73 mmol/l, Apo B > or = 104 mg/dl were of the same order of magnitude as being a current smoker, having a BMI > or = 24.3 kg/m2, and a history of hypertension. High HDL-cholesterol (> or = 1.39 mmol/l) and Apo AI (> or = 139 mg/dl) were protective factors. The odds ratios for successively higher quartile values of cholesterol were not statistically significant. Multiple logistic regression identified smoking habit, history of hypertension, obesity, high Apo B and low Apo AI concentrations as independent risk factors for myocardial infarction. CONCLUSIONS: In a Chinese population, low serum Apo AI and high Apo B are risk factors for myocardial infarction of a comparable magnitude to smoking, hypertension and obesity.