RESUMEN
The evaluation of iron status in dialysis patients provides information essential to the planning of adequate recombinant human erythropoietin treatment. To diagnose iron deficiency in patients undergoing hemodialysis (HD), reticulocyte hemoglobin content and percentage of hypochromic red cells are incorporated into the European best practice guidelines on anemia management in chronic kidney disease (CKD), the mean reticulocyte hemoglobin content (Ret-HE) was proposed as alternatives to standard biochemical tests. Reticulocyte hemoglobin content and percentage of hypochromic red cells are incorporated into the European best practice guidelines on anemia management in CKD. Our aim was to assess the value of Ret-HE parameter, in terms of the sensitivity and specificity for detecting iron deficiency, in HD patients. We studied 50 patients undergoing HD three times weekly , to clarify the accuracy of Ret-HE in diagnosing iron deficiency in dialysis patients, we initially compared Ret-HE with such iron parameters as serum ferritin levels, transferrin saturation, and hypochromic red blood cell (Hypo%) which has been established as indicators of functional iron deficiency. Ret-HE mean value in anemic patients was (25.84 ± 4.23 pg) and had good correlation (P <0.001) between Ret-HE, serum iron, ferritin, transferrin, and transferin saturation in dialysis patients. Receiver operating characteristic curve analysis revealed, values of the area was 0.887, and at a cutoff value of 27.0 pg, a sensitivity of 90.4% and a specificity of 80.8% were achieved. The newly proposed Ret-HE can provide clinicians with information equivalent to iron deficiency anemia markers. Ret-HE is a new parameter that is easily measurable is suggested as reliable parameters for the study of erythropoiesis status in HD patients.
Asunto(s)
Anemia Ferropénica/sangre , Anemia Ferropénica/diagnóstico , Hemoglobinas/metabolismo , Deficiencias de Hierro , Reticulocitos/metabolismo , Anciano , Anciano de 80 o más Años , Femenino , Ferritinas/sangre , Humanos , Hierro/sangre , Sobrecarga de Hierro/prevención & control , Masculino , Persona de Mediana Edad , Curva ROC , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Transferrina/metabolismoRESUMEN
Disorders associated with the hepatitis C virus (HCV) have been reported including cardiovascular, metabolic, and central nervous system diseases. Since chronic HCV infections may be curable, their identification as causal contributors to cardiovascular risk could offer new perspectives in the prevention of cardiovascular disease. The aim of this study is to investigate the association between HCV and aortic arch calcification (AAC) and corneal and conjunctival calcification (CCC) in maintenance hemodialysis (MHD) patients; further, we assessed the correlation of CCC with vascular calcification. A total of 100 patients undergoing hemodialysis (HD) in our hospital were included in this study. Patients underwent a complete ocular examination including intraocular pressure, and CCC was looked for by slit lamp and fundoscopy. CCC was graded according to modified Porter and Crombie classification system described by Tokuyama et al. Helical computerized tomographic chest examination was used to evaluate the grading of AAC. Demographic, hematological, biochemical, and dialysis-related data were obtained. There was significant difference between seropositive (n = 51) and seronegative patients (n = 49) regarding grading of AAC and CCC (P <0.001). Signiï¬cant positive correlation was found between grading of CCC, AAC, age (P <0.001), duration on HD (P <0.001), HCV-antibody positivity (P <0.001), serum calcium level (P <0.001), serum phosphorus level (P <0.001), calcium × phosphorus product (P <0.001), and i-parathormone level (P < 0.001). In addition, CCC grading positively correlated with AAC. Our results suggest that patients undergoing HD infected with the HCV have high degree of CCC, AAC, and mineral metabolism disorder. The strong correlation between CCC and AAC indicates that CCC evaluation is an easy, fast, non-invasive method, and might be used as an indirect indicator to detect vascular calcification in patients undergoing MHD.
Asunto(s)
Calcificación Vascular , Enfermedades Cardiovasculares , Hepatitis C , Humanos , Diálisis Renal , Factores de RiesgoRESUMEN
BACKGROUND: We assessed the effect of hepatitis C seropositivity on the percentage of various T-cells in living donor renal transplant recipients (LDRTRs) and their association with intercurrent infections post renal transplantation (post-Tx). METHODS: One hundred and thirty-three matching LDRTRs [A (seronegative) (68 patients) and B (seropositive) (65 patients) by ELISA] were studied prospectively 10 days, 6 months and 12 months post-Tx for intercurrent infections, acute rejection and T-cell% by flow cytometry. RESULTS: CD4(+), CD8(+), CD4/CD8 were significantly higher 10 days post-Tx in Group B compared to Group A, p < 0.001. A significant increase in CD8% was seen 6-month post-Tx among Group B compared to Group A. No difference was detected between groups in (CD4(+), CD8(+), CD4/CD8, CD3-CD16/65(+)%), rate and severity of intercurrent infection, rate of acute rejection, 12 months post-Tx. A significantly higher rate of severe infections particularly urinary tract infections (UTI) was noted in Group B compared to Group A the first 3 months post-Tx particularly in those who received the combination of antithymocyte globulin (ATG) or basiliximab, tacrolimus, steroids, mycophenolate mofetil (MMF). CD4(+)% correlated negatively with intercurrent infections in Group B 6 months post-Tx. CONCLUSION: HCV(+) patients are more prone to intercurrent infections the first 3 months post-Tx. Infection rate correlates positively with pre-transplant HCV seropositivity and immunosuppressive regimen.
Asunto(s)
Hepatitis C/complicaciones , Inmunosupresores/uso terapéutico , Fallo Renal Crónico/terapia , Trasplante de Riñón , Linfocitos T/citología , Infecciones Urinarias/epidemiología , Adolescente , Adulto , Anciano , Anticuerpos Monoclonales/uso terapéutico , Basiliximab , Relación CD4-CD8 , Niño , Egipto , Femenino , Rechazo de Injerto/epidemiología , Supervivencia de Injerto , Hepatitis C/sangre , Humanos , Masculino , Persona de Mediana Edad , Ácido Micofenólico/uso terapéutico , Estudios Prospectivos , Proteínas Recombinantes de Fusión/uso terapéutico , Análisis de Regresión , Tacrolimus/uso terapéutico , Adulto JovenRESUMEN
Patients undergoing dialysis are at high risk for cardiovascular disease (CVD). Mortality differences between peritoneal dialysis (PD) and hemodialysis (HD) are widely debated. The question of whether dialysis modality affects the risk for CVD remains to be addressed.In the present study, we evaluated the influence of hemodialysis (HD) and peritoneal dialysis (PD) on survival and the risk of developing de novo CVD. Our observational prospective study enrolled 157 end-stage renal disease patients on HD or PD for 12 months. Patients with a history of malignancy, chronic rheumatic heart disease, congenital heart disease, previous cardiac surgery, or previous transplantation, and patients started on dialysis less than 3 months earlier were excluded from the study. Detailed medical history, demographic data, and routine laboratory investigations were obtained, and patients were follow every 3 months for 12 months. Cardiac echography was performed at baseline and at 6 months. Nutrition status was scored using the standardized 7-point subjective global assessment (SGA). Baseline comorbidities included the presence or absence of coronary artery disease (angina, myocardial infarction, and coronary artery bypass surgery), peripheral vascular disease, hypertension, diabetes mellitus, and cerebrovascular disease.Of the 157 patients, 121 were on HD (60 men, 61 women; mean age: 59.3 years), and 36 were on PD (14 men, 22 women; mean age: 50.8 years, p = 0.13). The dialysis duration was significantly different in the two groups (HD: 52.96 ± 38.3; PD: 30.89 ± 26.3; p = 0.02). Of the HD patients, 95.04% were hypertensive, and 61.98% were diabetic; of the PD patients, 91.66% were hypertensive, and 50% were diabetic. Body mass index and SGA score were not significantly different between the two groups. Patients on PD had a higher residual urine volume (383.66 ± 548.393 mL vs. 12.40 ± 96.238 mL in the HD patients, p < 0.001).In comparing traditional cardiovascular risk factors at the start of the study, PD patients had higher levels of total cholesterol (4.5 ± 1.33 mmol/L vs. 3.85 ± 1.34 mmol/L in HD patients, p < 0.05), low-density lipoprotein cholesterol (2.84 ± 1.31 mmol/L vs. 2.06 ± 0.89 mmol/L, p < 0.001), high-density lipoprotein cholesterol (1.10 ± 0.26 mmol/L vs. 0.91 ± 0.32 mmol/L, p < 0.005). Cardiovascular morbidity affected 17 HD patients and 2 PD patients. A Cox proportional hazards model for cardiovascular events showed a trend suggesting that PD was safer, but the data did not reach statistical significance. Kaplan-Meir survival analysis revealed 12 death events in HD patients compared with 4 events in PD patients-a difference that was not statistically significant.Cardiovascular morbidity during chronic dialysis was prevalent among the older patients (>57 years) and those who used more than 1 antihypertensive medication; an ejection fraction exceeding 53% was found to be cardioprotective. For all-cause mortality, dialysis modality was a nonsignificant risk factor; age and Kt/V were significant.
Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Fallo Renal Crónico/terapia , Diálisis Peritoneal/métodos , Adulto , Anciano , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Dislipidemias/sangre , Dislipidemias/epidemiología , Egipto/epidemiología , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Diálisis Renal/métodosRESUMEN
To determine the relation between hepatitis C virus (HCV) genotype 4 and microalbuminuria in relation to hepatic histology and viremia in the absence of cryoglobulinemia and to examine the effect of treatment on microalbuminuria, we studied 400 HCV genotype-4-infected patients who were tested for microalbuminuria, albumin creatinine ratio (ACR), urea, creatinine and estimated glomerular filtration rate (eGFR). The parameters were measured again in the HCV patients after six months of treatment with pegylated interferon and ribavirin. Microalbuminuria was detected in 56 (14%) HCV-positive patients. There was a highly significant reduction in the microalbuminuria levels among the HCV-positive individuals after six months of therapy (P <0.001). Microalbuminuria was significantly associated with older age [Odds Ratio (OR): 1.1, 95% confidence interval (CI): 1.0-1.2, P = 0.01], elevated creatinine (OR: 0.09, 95% CI: 0.01- 0.7, P = 0.02), high modified Histological Activity Index score (OR: 1.5, 95% CI: 1.1-1.5, P = 0.004) and increased viral load (OR: 2.8, 95% CI: 1.1-6.6, P = 0.01). Sustained virological response (SRV) was achieved in 272 (86%) patients. The individuals with SVR had lower microalbuminuria post-treatment (P = 0.56). We conclude that HCV infection can be associated with microalbuminuria, which can be reduced by the use of a combination therapy of pegylated interferon-ribavirin.
Asunto(s)
Albuminuria/epidemiología , Adulto , Comorbilidad , Creatinina/sangre , Quimioterapia Combinada , Femenino , Genotipo , Hepacivirus/genética , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/genética , Humanos , Incidencia , Interferón-alfa/uso terapéutico , Persona de Mediana Edad , Análisis Multivariante , Estudios Prospectivos , Carga Viral , Adulto JovenRESUMEN
To evaluate the prevalence, risk factors, possible etiology, prognosis and management of proteinuria in renal transplant recipients, we studied 435 adult renal transplant recipient patients randomly selected from our center; 394 patients were reviewed retrospectively and 41 patients were followed-up prospectively for a period of one year. The patients were classified into three groups according to the results of urinalysis and spot urinary albumin creatinine ratio: Group A patients with normoalbuminuria; Group B patients with microalbuminuria; and Group C patients with macroalbuminuria. Persistent post-transplantation proteinuria was detected in 125 (28.8%) patients. The etiology of post-transplantation proteinuria included chronic allograft dysfunction in 44 (35.2%) patients, acute rejection in 40 (32%) patients, transplant glomerulopathy in eight (6.4%) patients, glomerular disease in 16 (12.8%) patients and other etiology in 17 (13.6%) patients. Proteinuric patients demonstrated significantly lower graft survival rates than did those without proteinuria (48.3% versus 51.7%, respectively; P = 0.017; Risk Ratio = 0.403; 95% confidence interval 0.188-0.862). We conclude that proteinuria is prevalent after kidney transplant in our population, and that it is most commonly associated with chronic allograft nephropathy, transplant glomerulopathy, glomerulonephritis and acute rejection. Post-transplant proteinuria is associated with decreased allograft survival.
Asunto(s)
Trasplante de Riñón , Proteinuria/epidemiología , Proteinuria/etiología , Adulto , Presión Sanguínea , Índice de Masa Corporal , Infecciones por Citomegalovirus/epidemiología , Egipto/epidemiología , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Glomerulonefritis/complicaciones , Rechazo de Injerto/complicaciones , Supervivencia de Injerto , Humanos , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Estudios Prospectivos , Proteinuria/terapia , Estudios Retrospectivos , Factores de Riesgo , Esquistosomiasis/epidemiologíaRESUMEN
Hepcidin may play a critical role in the response of patients with anemia to iron and erythropoiesis-stimulating agent therapy. To evaluate the factors affecting serum hepcidin levels and their relation to other indexes of anemia, iron metabolism and inflammation, as well as the dose of erythropoietin, we studied 80 maintenance hemodialysis (MHD) patients treated with recombinant human erythropoietin and their serum hepcidin levels were specifically measured by using a competitive enzyme-linked immunosorbent assay. In linear regression analysis, ferritin was found to be a significant predictor of hepcidin levels in all the study patients. In the absence of apparent inflammation, serum hepcidin levels correlated exclusively with ferritin levels in MHD patients, and it was also an independent marker of inflammation as highly sensitive C-reactive protein.
Asunto(s)
Anemia/etiología , Hepcidinas/sangre , Hierro/sangre , Fallo Renal Crónico/terapia , Diálisis Renal , Adulto , Anciano , Anemia/sangre , Anemia/diagnóstico , Anemia/tratamiento farmacológico , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Darbepoetina alfa , Epoetina alfa , Eritropoyetina/análogos & derivados , Eritropoyetina/uso terapéutico , Femenino , Ferritinas/sangre , Hematínicos/uso terapéutico , Homeostasis , Humanos , Mediadores de Inflamación/sangre , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/diagnóstico , Masculino , Persona de Mediana Edad , Proteínas Recombinantes/uso terapéutico , Diálisis Renal/efectos adversos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Fibroblast growth factor 23 (FGF-23) is a recently discovered regulator of phosphate and mineral metabolism and has been associated with both progression of CKD and mortality in dialysis patients. To evaluate the association between serum FGF-23 levels and echocardiographic measurements in long-term HD (HD) patients without cardiac symptoms, we studied 90 consecutive patients treated in a single HD center (51 males, 39 females; mean age 41.5 ± 14.2 years, mean HD duration 71.2 ± 14.2 months). Comprehensive echocardiography was performed after HD and blood samples were obtained before HD. The serum FGF-23 level in dialysis patients was 95.7 ± 88.4 pg/mL. In univariate analysis, serum calcium levels (r = 0.33, P <0.05), serum creatinine (r = 0.34, P <0.05), serum albumin (r = 0.35, P <0.05) and left ventricular mass index (LVMI) (r = 0.33, P <0.001) were correlated weakly with the FGF-23 levels. Neither s. phosphorus nor calcium x phosphorus product correlated with FGF-23. In univariate regression analysis, only LVMI [ß = 0.42, P <0.05, confidence interval (CI) 0.3-4.3], serum calcium (ß= 0.87, P <0.001, CI 0.8-7.3), serum albumin (ß= 0.87, P < 0.001, CI 0.8-7.3) and serum creatinine (ß= 0.67, P <0.05, CI 0.5-6.5) significantly correlated with FGF-23. FGF-23 was identified as a factor that is weakly associated with LVMI. Thus, FGF-23 alone may not be a parameter that can be used for evaluation of the cardiac status in HD patients.
Asunto(s)
Enfermedades Cardiovasculares/sangre , Factores de Crecimiento de Fibroblastos/sangre , Fallo Renal Crónico/terapia , Diálisis Renal , Adulto , Biomarcadores/sangre , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Distribución de Chi-Cuadrado , Ecocardiografía Doppler , Femenino , Factor-23 de Crecimiento de Fibroblastos , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/mortalidad , Modelos Lineales , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Diálisis Renal/efectos adversos , Diálisis Renal/mortalidad , Factores de Riesgo , Factores de TiempoRESUMEN
UNLABELLED: Contrast-induced nephropathy (CIN) is the third leading cause of acute kidney injury (AKI) in hospitalized patients. Diabetes mellitus remains a consistent independent predictor of contrast nephropathy. AIM: To determine frequency and predictors of contrast-induced nephropathy after cardiac catheterization in type II diabetic patients. PATIENTS AND METHODS: The study included 200 type II diabetic patients who underwent cardiac catheterization; serial measurement of serum creatinine and creatinine clearance (Before contrast exposure and 48 h), creatinine clearance was calculated using Cockcroft-Gault formula. Contrast-induced nephropathy was defined as rise in serum creatinine 48 h after contrast exposure of ≥0.5 mg/dL or increased >25% compared to base line creatinine. RESULTS: incidence of CIN in type II diabetic patients was 21.5%; incidence of CIN in diabetic patients with microalbuminuria was 17%, while incidence of CIN in patients with macroalbuminuria levels was 26%. There was a statistically significant difference between the patients who suffered from CIN post-procedure and patients who did not suffer from CIN regarding the ejection fraction and age with low ejection fraction and older patients in CIN group. Multiple logistic regression analysis for CIN predictors showed that pre-contrast serum creatinine to be the strongest predictor for being at risk of contrast-related, followed by age, and lastly albumin/creatinine ratio. CONCLUSION: Our findings suggest that diabetic patients, despite having a normal baseline creatinine are at an increased risk of developing CIN post-coronary angiography, patients at risk of CIN are older patients with high pre-contrast serum creatinine and high urine albumin/creatinine ratio.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Cateterismo Cardíaco/efectos adversos , Medios de Contraste/efectos adversos , Angiografía Coronaria/efectos adversos , Diabetes Mellitus Tipo 2/complicaciones , Intervención Coronaria Percutánea/efectos adversos , Lesión Renal Aguda/sangre , Lesión Renal Aguda/epidemiología , Adulto , Factores de Edad , Anciano , Albuminuria/complicaciones , Nitrógeno de la Urea Sanguínea , Cateterismo Cardíaco/métodos , Angiografía Coronaria/métodos , Creatinina/sangre , Diabetes Mellitus Tipo 2/sangre , Nefropatías Diabéticas/complicaciones , Femenino , Tasa de Filtración Glomerular , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/métodos , Factores de RiesgoRESUMEN
To evaluate the individualization of dialysate sodium (Na + ) concentration in hemodialysis (HD), we studied 40 stable chronic HD patients in a single-blind crossover design. They underwent 36 consecutive HD sessions with the dialysate Na + concentration set at 138 mmol/L, followed by 36 sessions of dialysate Na + set to match the patients average pre-HD plasma Na + levels. We multiplied the midweek pre-HD measured Na + by the Donnan coefficient of 0.95 (individualized Na + ). Pre-HD Na + dialysis sodium levels were nearly constant, with no variation between the two phases and a mean of 137.45 ± 2.04 mmol/L. Post-HD serum Na + was significantly higher during the standard phase (139.7 ± 2 mmol/L) than during the individualized phase (137.1 ± 1.6 mmol/L). Also, interdialytic weight gain (IDWG) was significantly more reduced during the individualized phase (3.25 ± 0.56%) than during the standard phase (3.94 ± 0.92%), P <0.001. Episodes of distressing symptoms including headache, muscle cramps and hypotension were significantly less frequent in the individualized phase. The mean of the pre-HD and post-HD systolic and diastolic blood pressures significantly decreased during the individualized phase, and we could reduce the doses of antihypertensive drugs in 10 (33.33%) patients. Individualized dialysate Na + concentration was associated with a decrease in IDWG and dialysis hypotension and related symptoms and better BP control in stable chronic HD patients.
Asunto(s)
Soluciones para Hemodiálisis/uso terapéutico , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Sodio/análisis , Adulto , Anciano , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Estudios Cruzados , Egipto , Femenino , Soluciones para Hemodiálisis/efectos adversos , Soluciones para Hemodiálisis/química , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/etiología , Hipertensión/fisiopatología , Hipotensión/etiología , Hipotensión/fisiopatología , Modelos Lineales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/complicaciones , Método Simple Ciego , Sodio/sangre , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
UNLABELLED: The significance of glycated albumin (GA) compared with casual plasma glucose (PG) and glycated hemoglobin (HbA1c) was evaluated as an indicator of the glycemic control state in hemodialysis (HD) patients with diabetes. In HD patients with diabetes (n = 25), the mean PG, GA and HbA1c levels were 192.9 + 23 mg/dL, 278.8 + 43 µmol/L and 5.9 + 0.5%, respectively, which were higher by 43.9%, 67.04% and 18%, respectively, compared with HD patients without diabetes (n = 25). HbA1c levels were significantly lower than simultaneous PG and GA values in those patients in comparison with the three parameters in patients who had diabetes without renal dysfunction (n = 25). A significant negative correlation was found between GA and serum albumin (r = 0.21, P <0.05) in HD patients with diabetes, whereas HbA1c correlated positively and negatively with hemoglobin (r = 0.11, P <0.01) and weekly dose of erythropoietin injection (r = -0.19, P < 0.01), respectively. Although PG and GA did not differ significantly between HD patients with diabetes and with and without erythropoietin injection, HbA1c levels were significantly higher in patients without erythropoietin. Categorization of glycemic control into arbitrary quartiles by GA level led to better glycemic control in a significantly higher proportion of HD patients with diabetes than those assessed by HA1c. Multiple regression analysis demonstrated that hemoglobin in addition to PG emerged as an independent factor associated with HbA1c in HD patients with diabetes, while PG, body mass index and albumin were an independent factor associated with GA. CONCLUSION: it is suggested that GA provides a significantly better measure to estimate glycemic control in HD patients with diabetes and that the assessment of glycemic control by HbA1c in these patients might lead to likely underestimation as a result of the increasing proportion of young erythrocyte by the use of erythropoietin.
Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Hemoglobina Glucada/metabolismo , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Albúmina Sérica/metabolismo , Adulto , Anemia/sangre , Anemia/tratamiento farmacológico , Biomarcadores/sangre , Glucemia/efectos de los fármacos , Distribución de Chi-Cuadrado , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Egipto , Eritropoyetina/uso terapéutico , Femenino , Productos Finales de Glicación Avanzada , Hematínicos/uso terapéutico , Humanos , Hipoglucemiantes/uso terapéutico , Riñón/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Reproducibilidad de los Resultados , Factores de Tiempo , Albúmina Sérica GlicadaRESUMEN
Cognitive dysfunction includes reduced mental alertness, intellectual impairment, decreased attention and concentration, memory deficits and diminished perceptual-motor coordination. Chronic kidney disease (CKD) patients may suffer from cognitive impairment, which may decrease an individual's quality of life, increase resource utilization and result in suboptimal medical care. This study was carried out on 120 patients with different stages of CKD from our nephrology outpatient clinic divided into three groups: Group I: 50 CKD patients, stage 3 and stage 4; Group II: 50 end-stage renal disease patients on regular hemodialysis with K t/v >1.1; and Group III: 20 acute kidney injury patients, followed-up till their renal functions stabilized besides Group IV: 20 healthy subjects served as controls. All patients underwent laboratory investigations and psychometric tests, which include trial making test part B, digit span test, digit symbol test and mini-mental state examination. There was a significant difference of mean values of cognitive function tests in Groups I, II and III on comparing them with Group IV. Stage 3 CKD scored better than stage 4 CKD, which was worse than hemodialysis patients, and lastly acute kidney injury patients had mild cognitive impairment, which was restored after recovery. We found an association between hemoglobin and cognitive function tests score in the studied groups. The degree of cognitive impairment was associated with the severity of CKD, and dialysis improved cognitive performance.
Asunto(s)
Lesión Renal Aguda/complicaciones , Trastornos del Conocimiento/etiología , Cognición , Insuficiencia Renal Crónica/complicaciones , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/psicología , Adulto , Análisis de Varianza , Estudios de Casos y Controles , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/psicología , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/psicología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Valor Predictivo de las Pruebas , Escalas de Valoración Psiquiátrica , Psicometría , Diálisis Renal , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/psicología , Insuficiencia Renal Crónica/terapia , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
In some renal allograft recipients, anemia persists or develops following transplantation. Anemia is associated with pre-operative blood loss and allograft dysfunction, including delayed graft function, acute rejection and chronic allograft dysfunction. To study the prevalence and association of post-renal transplant anemia, we studied 200 renal transplant recipients; 131 (65.5%) patients were males and 69 (34.5%) patients were females, and age ranged from 17 to 67 years, with a mean of 37.7 ± 10.8 years. All patients were receiving cyclosporine, prednisolone and mycophenolate mofetil (MMF). Complete blood count was done at two times: three and six months post-renal transplant. There were 74% anemic patients three months after renal transplantation and 45% anemic patients six months after renal transplantation. High creatinine value, female gender, delayed graft function, episodes of acute rejection, perioperative blood loss and infections were the only significant independent risk factors for prevalence of anemia post-renal transplant. In our study, we did not find an association between MMF and cyclosporine nor angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptors blocker (ARBs) with anemia. This study demonstrates that anemia is a common complication during the first six months after kidney transplantation, with several risk factors precipitating this complication.