RESUMEN

Central venous stenosis (CVS) refers to a significant stenosis of a large intrathoracic vein, such as the subclavian, brachiocephalic, or the superior vena cava (hemodialysis, HD). Percutaneous transluminal angioplasty (PTA) with or without stent placement has been the recommended as the preferred approach to CVS. A total of 10 consecutive HD patients with documented CVS over a 2-year time period from April 2017-April 2019 underwent percutaneous angioplasty and stent insertions under sedation. The procedure was performed by the interventional cardiologist in the institute. One patient underwent only PTA, whereas nine (90%) had PTA with primary stent insertion. Primary patency was 90% at 3 months, 80% at 6 months while at 12 months, it was 70% and remained at 70% at 24 months. We did not find any association between age, gender, diabetic status, dialysis vintage, or previous catheter infection with procedural patency. Central venous stenosis can be treated successfully with percutaneous angioplasty and primary stenting. Despite advances, prevention of CVS should be the primary approach.

RESUMEN

The prevalence of chronic kidney disease (CKD) has increased substantially in India over the past two decades commensurate with the global trend and has currently emerged as a significant cause of mortality and morbidity. Use of complementary and alternative medicine (CAM), especially ayurvedic medication, is widespread in CKD although accurate data on the prevalence of use are lacking. A cross-sectional study was conducted from January to June 2017 in the nephrology outpatient clinic of a medical college hospital in Mangalore, South-West India. Adult patients (>18 years) with CKD (estimated glomerular filtration rate ≤60 mL/min) were considered potentially eligible and approached to participate in the survey. A 17-item semi-structured questionnaire adapted from the National Health Interview Survey Adult CAM Supplement was used for the study. A total of 278 patients (194 males and 84 females) with a mean age of 49.04 ± 12.06 years were included in the study; 67.3% were unemployed and married (83.8%), 35.6% had primary school education, more than 2/3rd of the patients had CKD Stage 5, and 110 patients were on renal replacement therapy with hemodialysis. Comorbidities such as hypertension were present in 46.8%, whereas 36.7% of the patients were diabetic. One hundred and eighty-four patients interviewed (66.3%) reported the use of one or more types of CAM therapy in the previous six months. Herbal and dietary supplements were used by 13 (7.1%); ayurvedic medication by 117 (63.6%); naturopathic, homeopathic, and Unani systems by 30 (16.3%), while spiritual/faith healing and acupuncture were used by 16 (8.7%) and eight (4.3%) of the patients, respectively. A multiple regression analysis between CAM users and non-users revealed that older age (P = 0.004), occupational status (P = 0.035), and income (P = 0.006) correlated strongly with CAM use. The present study highlights the high prevalence (66%) of use of alternative medication in patients with CKD.

Asunto(s)

RESUMEN

BACKGROUND: Acute kidney injury (AKI) after cardiac surgery is a frequent post-operative complication associated with an increased risk of mortality, morbidity and hospital costs. Preoperative risk scores such as the Cleveland Clinic Scoring Tool (CCST) have been validated in Western population group to identify patients at higher risk of AKI and may facilitate preventive strategies. However, the scoring tool has not been validated systematically in a South Asian cohort. We aimed to evaluate the applicability of the CCST in prediction of AKI after open cardiac surgery in a South-Indian tertiary care center. MATERIALS AND METHODS: A retrospective study of all patients who underwent elective open cardiac surgery over a 4year period from Jan 2012 to Dec 2015 at a single centre were included and relevant details extracted from a comprehensive chart review. The primary outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Patients were risk stratified as per the CCST to assess for prediction of AKI into low risk (0-2), intermediate risk (3-5) and high risk (>6) groups. RESULTS: A total of 276 patients underwent open cardiac surgery with mean age of 51.5±13.06 yrs. This included 177 (64.1%) males and 99 females (35.8%). Overall incidence of AKI was 6.88%. Mean age, gender, BMI, preoperative serum creatinine, diabetes mellitus, chronic obstructive pulmonary disease, cardiopulmonary bypass time was similar in patients who developed AKI vs those who did not have AKI postoperatively. The mean CCST scores were 1.6 in those without AKI, 1.5 in stage 1, 3.0 in stage 2 and 3.4 in stage 3 AKI. Higher risk scores predicted greater risk of AKI. A total of 106 patients (38.4%) were on ACE/ARB, 119 patients (43.1%) received beta-blockers, 110 (39.8%) received diuretics while 144(52.1%) had received preoperative statins. Comparison of drug use between the two groups revealed that preoperative use of ACEI/ARB was associated with highest risk of AKI (p=0.006). Mortality rate was also high at 15.7% in those with AKI compared to 3.1% in non-AKI group (p=0.04). CONCLUSION: The modified CCST was valid in risk identification of patients with severe stage of AKI but did not have strong discrimination for early AKI stages. Preoperative statin use did not protect against AKI in our study, however preoperative ARB/ACEI use was significantly associated with occurrence of postoperative AKI.

Asunto(s)

RESUMEN

INTRODUCTION: The term plasmapheresis/plasma exchange refers to the removal of the plasma component of blood and its replacement with various fluids. Plasma Exchange (PE) has been used to treat a variety of conditions that are associated with an aberrant immune response. We undertook this retrospective study aiming to look at plasmapheresis procedures conducted in the nephrology department over a fixed time period. MATERIALS AND METHODS: Retrospective analysis of PE procedures from January 2013 to October 2016 was conducted in the nephrology and Intensive Care Unit of a tertiary care teaching hospital. The goal was to achieve a total removal of 150-200 ml/plasma per kg body weight. As replacement, we used a standard protocol of 100 ml of 20% albumin in 1 L of normal saline and 2-3 units of fresh frozen plasma. All results were expressed as mean ± standard deviation and statistical analysis was done using the Student's t-test for continuous and Fisher's exact test for categorical data. RESULTS: A total of 192 procedures performed on 40 patients (22 males and 18 females). Age ranged from 15 to 79 years with a mean age of 37.5 years. Guillain-Barre syndrome accounted for 67.5% (>two-third of causes) for PE. Vascular access was femoral catheter in 27 (67.5%) and internal jugular catheter in 13 (32.5%). Mild hypotension occurred in 15 procedures (7.8%) of patients and allergic reactions such as rashes and chills occurred in 5 cycles (2.6%). A total of 36 patients (90%) showed significant improvement in condition, 2 did not show any change, while one worsened and one died due to respiratory complications. CONCLUSION: Our small series of data of plasmapheresis procedures from nephrology perspective has reaffirmed the safety and efficacy of the therapy in an experienced setup.