RESUMEN
BACKGROUND: Elevated serum levels of homocysteine have increasingly been associated as a risk factor of cardiovascular disease. Recent reports demonstrated that supplements of folates, vitamin B12 (B12) and vitamin B6 (B6) are effective in correcting serum Hcy levels in hemodialysed patients. AIM: to assess the effectiveness of oral supplements of folates, B12 and B6, in order to reduce serum Hcy levels in our cohort of hemodialysed patients. METHODS: Sixty-one hemodialysed patients have been enrolled in the study (age 68+/-13 years; hemodialysis 62+/-42 months). Oral supplements of calcium folinate (30 mg 3 times a week), B12 (500 mg 3 times a week) and B6 (200 mg 3 times a week) were administered at the end of each hemodialysis session. Serum levels of Hcy, folic acid and B12 were tested at the beginning of the study and at 2 month intervals. RESULTS: After 5 months of follow-up, serum levels of Hcy were normalised in 19% of our patients and in total 70% of them showed a reduction >8% when compared with the basal Hcy levels. No side effects related to folates, B12 or B6 supplementation were observed. CONCLUSIONS: Oral supplements of folates, B12 and B6 are a safe and effective treatment of hyperhomocysteinemia in hemodialysed patients.
Asunto(s)
Suplementos Dietéticos , Ácido Fólico/administración & dosificación , Diálisis Renal , Vitamina B 12/administración & dosificación , Vitamina B 6/administración & dosificación , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
BACKGROUND AND AIMS: This study reports a retrospective evaluation of the predominance of infection in 67 dual lumen central venous catheters (CVC), 35 of which were positioned in the femoral vein by the nephrological team and 32 in the subclavian vein by anesthetists. METHODS: The microorganisms responsible for infection, the prevalence of clinically symptomatic infections, the relationship between CVC-correlated infection and the time the catheter remained inserted were evaluated, together with a comparison between the two different insertion sites. RESULTS: Culture tests, performed using Maki's semiquantitative technique, gave positive results in 16/67 (23.8%) cases. The main pathogenic agents found were Staphylococcus epidermidis (37.5%) and Staphylococcus aureus (31.2%). In 3/16 cases (18.78%) infections were clinically symptomatic. The mean permanence of CVC with positive cultures was not statistically different to the mean permanence of CVC with negative cultures (22.44 +/- 13.48 vs 18.38 +/- 17.76). The microorganisms isolated on femoral and subclavian catheters showed a comparable distribution and the prevalence of infection was not statistically different in the two insertion sites. CONCLUSIONS: In conclusion, in the absence of infection, the authors tend to keep working catheters in the site, thus avoiding repeated invasive manoeuvres for replacement and/or repositioning, whereas in the presence of suspected systemic infection they feel it is more prudent to remove the CVC without waiting for the results of the hemoculture, starting first empiric and then specific antibiotic treatment on the basis of the antibiogram.
Asunto(s)
Infecciones Bacterianas/microbiología , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Humanos , Estudios RetrospectivosRESUMEN
To define which noninvasive investigations are of value in predicting bone histology, we analyzed transiliac bone specimens (66 biopsies, 14 autopsies) from 80 uremic patients on chronic dialysis. Results were compared with values of different measurements of parathyroid hormone (PTH), alkaline phosphatase (APH), osteocalcin, calcitonin, baseline and post-deferroxamine (DFO) aluminium (Al),--beta 2 microglobulin, ferritin and bone mineral density. Among histomorphometric parameters, woven osteoid, active osteoblastic surface and resorption surface showed the best correlations with dynamic and biochemical marks of active bone metabolism. Among biochemical parameters, intact PTH and APH were better related to histomorphometric and dynamic bone parameters than other PTH measurements as well as osteocalcin, while calcitonin was related to no parameters. Stainable Al alone, and not total bone Al content was related to bone histology. Baseline Al was related to lamellar osteoid, while post-DFO Al was related to stainable Al. beta 2 microglobulin was positively related to active osteoid surface and ferritin was inversely related to the mineral apposition rate, while bone mineral density was related only to total bone volume. We conclude that, though definite diagnosis requires the use of histological methods, few simple biochemical parameters may offer insight to the bone metabolic status, useful to the physician in day to day clinical practice.
Asunto(s)
Biomarcadores/análisis , Densidad Ósea/fisiología , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/patología , Ilion/patología , Diálisis Renal/efectos adversos , Absorciometría de Fotón , Adulto , Anciano , Anciano de 80 o más Años , Aluminio/análisis , Resorción Ósea , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/diagnóstico , Femenino , Ferritinas/sangre , Humanos , Ilion/metabolismo , Modelos Lineales , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/sangre , Valor Predictivo de las Pruebas , Uremia , Microglobulina beta-2/análisisRESUMEN
The ministerial decrees of 15/4/94 and 14/12/94 defined the new payment schedules for hospital services during ordinary and day hospitalization; the hospital discharge form (SDO) is the main source of this information. The services are defined by the classification of ROD ("raggruppamenti omogenei di diagnosi"), adapted from the American DRG ("Diagnosis related groups"), which have substituted the traditional system of payment by production factor. On the basis of the DRG identified and the length of hospital stay, the Region pays the hospital the cost of hospitalization. The main diagnosis at discharge, secondary diagnosis, complications and diagnostic/therapeutic procedures all contribute to the determination of 489 DRG. Groups of pathologies are reclassified into 25 MDC ("Major Diagnostic Categories"). The 11th MDC includes the uronephrological DRG (302-333). The nephrological sector has been penalized by the inadequate value given to related procedures and diagnostic limitations. In order to guarantee efficacious diagnostic and therapeutic procedures, without impoverishing the nephrological budget and reducing the management autonomy of the divisions and autonomous services with hospitalization, it is necessary to introduce quality controls and corrective measures to the procedures that maintain the value of diagnosis and comply with financial considerations.
Asunto(s)
Grupos Diagnósticos Relacionados , Hospitalización/economía , Enfermedades Renales/economía , Mecanismo de Reembolso , Medicina Estatal/economía , Adolescente , Adulto , Anciano , Presupuestos , Niño , Pruebas Diagnósticas de Rutina/economía , Agencias Gubernamentales/economía , Costos de Hospital , Humanos , Italia , Enfermedades Renales/diagnóstico , Enfermedades Renales/terapia , Persona de Mediana Edad , Medicina Estatal/legislación & jurisprudenciaRESUMEN
Prevalence of hepatitis C virus (HCV) varies in the dialytic population according to the geographic area (5-85%); the European average is 19%, with marked differences between dialysis units. The means of virus transmission is still not clear and represents one of the major management problems faced by dialysis units. US authors and European study groups have recently demonstrated a high level od HCV infection in patients with essential mixed cryoglobulinemia (EMC), suggesting that the virus plays an etiological role. The authors examined the correlation between mixed cryoglobulinemia and HCV and the possible etiological role of the virus in the pool of patients undergoing dialysis at the Centre. In September 1994 28/63 (44.4%) patients were found to be Ab anti-HCV positive (second and third generation ELISA); circulating cryoglobulins identified as Type II following immunofixation were found in 2/28 patients (7%) using centrifugation and cold incubation techniques. In the absence of the pathologies classically associated with cryoglobulinemia, the patients were diagnoses as suffering EMC. The HCV/EMC correlation in the dialysed population has been analysed in a limited number of studies, with discrepant results (0-47%). This paper highlights the association between HCV and EMC in 7% of chronic dialysed patients and given that the finding of anti-HCV Ab in serum solely documents previous exposure to the virus, we can only indirectly attribute an etiological role to HCV. The search for viral RNA in the serum, cryocrit and surnatant of patients found affected by EMC may provide additional etiopathogenetic information.
Asunto(s)
Crioglobulinemia/etiología , Hepatitis C/complicaciones , Diálisis Renal/efectos adversos , Anciano , Crioglobulinemia/epidemiología , Crioglobulinas/clasificación , Ensayo de Inmunoadsorción Enzimática , Europa (Continente)/epidemiología , Femenino , Hepatitis C/epidemiología , Hepatitis C/transmisión , Anticuerpos contra la Hepatitis C/sangre , Humanos , Italia/epidemiología , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
To define the prevalence of NANB hepatitis, anti-HCV antibodies were determined in 51 patients on renal replacement therapy, in 7 transplanted patients and 17 staff members of the hemodialysis unit. Anti-HCV antibodies were evaluated using immunoenzymatic methods (Ortho HCV ELISA Test System, 1st and 2nd generation). Among hemodialysis patients, seroconversion was respectively documented in 17.6% (9/51) and 52.9% (27/51); none of the transplanted patients were positive with the 1st generation test, while 3/7 were positive with the 2nd. No statistically significant difference was found in the prevalence antibodies between transfused and nontransfused patients. ALT levels were statistically greater in patients with anti-HCV antibodies (X2 2nd generation = 8.83; p less than 0.01). Our results suggest: (1) that hemodialysis represents a risk factor; (2) the validity of substitute markers and (3) more sensitivity of the 2nd than 1st generation test.
Asunto(s)
Unidades de Hemodiálisis en Hospital , Hepatitis C/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Alanina Transaminasa/sangre , Femenino , Hepacivirus/inmunología , Anticuerpos Antihepatitis/sangre , Hepatitis C/inmunología , Hepatitis C/transmisión , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Personal de Hospital , Diálisis Renal/efectos adversos , Factores de RiesgoRESUMEN
The present study aimed to assess the serum levels of tumor necrosis factor (TNFalpha) and Interleukin-1 (IL-1) in uremic patients and those patients undergoing extracorporeal replacement therapy in relation to the duration of dialysis and the type of membrane. Serum cytokine values were assayed using an immunoradiometric technique (monoclonal antibodies) in 28 uremic patients and 7 healthy controls. TNFalpha levels were normal in control subjects but increased in uremic patients. Patients undergoing hemodialytic treatment showed increases which were statistically significant in comparison to basal levels, with a trend which was directly correlated to the duration of dialysis. No significant variations were induced by the different types of dialysis membranes used. In virtually all patients IL-1 values could not be assayed using this method.
Asunto(s)
Interleucina-1/sangre , Diálisis Renal , Factor de Necrosis Tumoral alfa/análisis , Uremia/sangre , Resinas Acrílicas , Acrilonitrilo/análogos & derivados , Adulto , Anciano , Celulosa/análogos & derivados , Femenino , Humanos , Interferones/sangre , Interleucinas/sangre , Masculino , Membranas Artificiales , Persona de Mediana Edad , Diálisis Renal/instrumentación , Uremia/terapiaAsunto(s)
Antihipertensivos/farmacología , Riñón/efectos de los fármacos , Antagonistas Adrenérgicos beta/efectos adversos , Antagonistas Adrenérgicos beta/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Antihipertensivos/efectos adversos , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/farmacología , Humanos , Enfermedades Renales/inducido químicamente , Enfermedades Renales/complicacionesAsunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Proteínas en la Dieta/administración & dosificación , Glomerulonefritis Membranoproliferativa/terapia , Glomerulonefritis Membranosa/terapia , Fósforo/administración & dosificación , Adulto , Aminoácidos Esenciales/administración & dosificación , Enfermedad Crónica , Terapia Combinada , Enalapril/uso terapéutico , Femenino , Glomerulonefritis Membranoproliferativa/dietoterapia , Glomerulonefritis Membranoproliferativa/tratamiento farmacológico , Glomerulonefritis Membranosa/dietoterapia , Glomerulonefritis Membranosa/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Proteinuria/prevención & controlRESUMEN
Albino rats were kept for long periods on a steatogenous, hypoproteic, hyperlipidic diets, either with or without choline. Serum protein and liver soluble protein and enzyme values showed changes that were only partly similar to those observed in human and experimental cirrhosis. The main features, in fact, were an absolute and percent decrease in albumins, an increase in serum alpha1-globulins and alpha proteins generally, and, more particularly, a constant fall in gamma-globulins and enzymes migrating to this site.