RESUMEN

INTRODUCTION: In some studies, the peritoneal solute transfer rate (PSTR) through the peritoneal membrane has been related to an increased risk of mortality. It has been observed in the literature that those patients with rapid diffusion of solutes through the peritoneal membrane (high/fast transfer) and probably those with high average transfer characterized by the Peritoneal Equilibrium Test (PET) are associated with higher mortality compared to those patients who have a slow transfer rate. However, some authors have not documented this fact. In the present study, we want to evaluate the (etiological) relationship between the characteristics of peritoneal membrane transfer and mortality and survival of the technique in an incident population on peritoneal dialysis in RTS Colombia during the years 2007-2017 using a competing risk model. MATERIALS AND METHODS: A retrospective cohort study was carried out at RTS Colombia in the period between 2007 and 2017. In total, there were 8170 incident patients older than 18 years, who had a Peritoneal Equilibration Test (PET) between 28 and 180 days from the start of therapy. Demographic, clinical, and laboratory variables were evaluated. The (etiological) relationship between the type of peritoneal solute transfer rate at the start of therapy and overall mortality and technique survival were analyzed using a competing risk model (cause-specific proportional hazard model described by Royston-Lambert). RESULTS: Patients were classified into four categories based on the PET result: Slow/Low transfer (16.0%), low average (35.4%), high average (32.9%), and High/Fast transfer (15.7%). During follow-up, with a median of 730 days, 3025 (37.02%) patients died, 1079 (13.2%) were transferred to hemodialysis and 661 (8.1%) were transplanted. In the analysis of competing risks, adjusted for age, sex, presence of DM, HTA, body mass index, residual function, albumin, hemoglobin, phosphorus, and modality of PD at the start of therapy, we found cause-specific HR (HRce) for high/fast transfer was 1.13 (95% CI 0.98-1.30) p = 0.078, high average 1.08 (95% CI 0.96-1.22) p = 0.195, low average 1.09 (95% CI 0.96-1.22) p = 0.156 compared to the low/slow transfer rate. For technique survival, cause-specific HR for high/rapid transfer of 1.22 (95% CI 0.98-1.52) p = 0.66, high average HR was 1.10 (95% CI 0.91-1.33) p = 0.296, low average HR of 1.03 (95% CI 0.85-1.24) p = 0.733 compared with the low/slow transfer rate, adjusted for age, sex, DM, HTA, BMI, residual renal function, albumin, phosphorus, hemoglobin, and PD modality at start of therapy. Non-significant differences. CONCLUSIONS: When evaluating the etiological relationship between the type of peritoneal solute transfer rate and overall mortality and survival of the technique using a competing risk model, we found no etiological relationship between the characteristics of peritoneal membrane transfer according to the classification given by Twardowski assessed at the start of peritoneal dialysis therapy and overall mortality or technique survival in adjusted models. The analysis will then be made from the prognostic model with the purpose of predicting the risk of mortality and survival of the technique using the risk subdistribution model (Fine & Gray).

Asunto(s)

Diálisis Peritoneal , Insuficiencia Renal Crónica , Humanos , Colombia/epidemiología , Estudios Retrospectivos , Masculino , Femenino , Diálisis Peritoneal/mortalidad , Persona de Mediana Edad , Insuficiencia Renal Crónica/terapia , Insuficiencia Renal Crónica/mortalidad , Adulto , Factores de Tiempo , Anciano , Peritoneo/metabolismo , Tasa de Supervivencia , Soluciones para Diálisis/química

RESUMEN

Resumen: La insuficiencia renal aguda al interior de la Unidad de Cuidados Intensivos es una condición clínica muy frecuente. Es consecuencia de los múltiples escenarios presentados durante el tiempo de estancia que pueden ir desde los diferentes tipos de choque, pasando por las intoxicaciones e infecciones hasta la polimedicación de nuestros pacientes. Su manifestación depende de la predisposición genética, del tipo de injuria, del grado de respuesta del huésped y su relación en la línea de tiempo en términos de disfunción orgánica múltiple, lo cual hace impredecible su instauración. El uso de la membrana peritoneal al interior de la Unidad de Cuidados Intensivos como primera línea de intervención para realizar diálisis de solutos y de solventes en pacientes adultos críticamente enfermos no es usual; sin embargo, la utilización de diálisis peritoneal se relaciona con excelentes resultados en términos de tiempo de estancia, mortalidad, infecciones adquiridas al interior de la unidad y recuperación de función renal residual consistente con la revisión en la literatura médica. Presentamos el caso clínico de una mujer en la sexta década de la vida, quien desarrolló falla renal aguda, desde el riesgo de injuria renal pasó rápidamente a la injuria renal leve y a la insuficiencia, por lo que requirió diálisis peritoneal que se sumó a una importante casuística clínica generada en los últimos cinco años al interior de nuestra organización.

---

Abstract: Acute renal failure within the intensive care unit is a very frequent clinical condition. Is the consequence of the multiple settings presented during the stay that can goes from the different types of shock, through poisonings and infections to the polymedication of our patients. Its manifestation depends on the genetic predisposition, the type of injury, the degree of response of the host and its relationship in the timeline in terms of multiple organ dysfunction, which makes its establishment unpredictable. The use of the peritoneal membrane inside the intensive care unit as the first line of intervention to perform dialysis of solutes and solvents in critically ill adult patients is not usual, however the peritoneal dialysis has shown excellent results in time of stay, mortality, infections acquired inside the unit and recovery of residual renal function consistent with medical literature. We present the clinical case of a woman in the sixth decade of life who developed acute renal failure from the risk of renal injury quickly moving to renal injury and failure requiring peritoneal dialysis, adding to an important clinical casuistry generated in the last five years within our organization.

---

Resumo: A insuficiência renal aguda dentro da unidade de terapia intensiva é uma condição clínica muito frequente. É consequência dos múltiplos cenários apresentados durante a estadia que vão desde os diferentes tipos de choque, passando por intoxicações e infecções até à polimedicação dos nossos doentes. Sua manifestação depende da predisposição genética, do tipo de lesão, do grau de resposta do hospedeiro e de sua relação na linha do tempo em termos de disfunção de múltiplos órgãos, o que torna seu estabelecimento imprevisível. A utilização da membrana peritoneal dentro da unidade de terapia intensiva como primeira linha de intervenção para realização de diálise de solutos e solventes em pacientes adultos em estado grave não é usual; no entanto, o uso da diálise peritoneal está associado a excelentes resultados em termos de tempo de internação, mortalidade, infecções adquiridas na unidade e recuperação da função renal residual condizente com a revisão da literatura médica. Apresentamos o caso clínico de uma mulher na sexta década de vida que desenvolveu insuficiência renal aguda com risco de lesão renal passando rapidamente para lesão renal leve e insuficiência com necessidade de diálise peritoneal, somando-se a um importante casuística clínica gerada nos últimos cinco anos dentro de nossa organização.

RESUMEN

RESUMO Nas últimas décadas, têm-se observado o crescimento da demanda de água e o agravamento dos cenários de escassez hídrica, bem como a ampliação de alternativas de reuso de água de efluentes de qualidade inferior, em particular de esgotos domésticos tratados. Objetivou-se, com este trabalho, avaliar a influência do substrato de pó de coco no controle de transporte de solutos em solos irrigados com esgoto tratado doméstico. A água residuária doméstica tratada provém da Unidade Experimental de Tratamento e Reúso Hidroagrícola, no distrito de Mutuca-PE. O delineamento experimental foi em esquema fatorial (2 × 3), cujos fatores avaliados compreenderam dois tipos de solos típicos da região (Neossolo Litólico e Argissolo Amarelo) e três tratamentos (sem pó de coco, 1 cm de pó de coco e 2 cm de pó de coco), com cinco repetições. Os parâmetros de transporte dos íons sódio e potássio foram obtidos por ajuste numérico, utilizando-se o modelo STANMOD. Constatou-se a existência de interação com soluto, sódio e potássio, em solo arenoso. O modelo STANMOD apresentou ótimo desempenho na simulação do transporte de solutos no solo. A cobertura de pó de coco mostrou-se eficiente na diminuição da lixiviação de íons em ambos os solos estudados.

---

ABSTRACT In the last decades, there has been an increase in the demand for water and the aggravation of water scarcity scenarios, as well as the expansion of water reuse alternatives for lower quality effluents, in particular treated domestic sewage. The objective of this study was to evaluate the influence of coconut powder substrate on the control of solute transport in irrigated soils with treated sewage reuse. The treated domestic wastewater comes from the Experimental Unit for Treatment and Agricultural Reuse in the district of Mutuca, Pernambuco. The experimental design was in a factorial scheme (2 × 3), whose evaluated factors comprised two types of soils typical of the region (Leptosols and Yellow Argisol) and three treatments (no coconut powder, 1 cm coconut powder, and 2 cm coconut powder) with five replicates. The transport parameters of the sodium and potassium ions were obtained by numerical adjustment using the STANMOD model. It was found the existence of interaction with solute, sodium, and potassium in sandy soil. The STANMOD model presented excellent performance in the simulation of solute transport in the soil. Soil coverage with coconut powder was shown to be efficient in reducing leaching of ions in both studied soils.

RESUMEN

Este trabalho tem como objetivos projetar e avaliar o potencial de colunas de solo não-saturado equipadas com sondas de TDR (Time domain reflectometry) e acopladas a um sistema automatizado de aquisição de dados no monitoramento da dinâmica da água e de potássio no solo. O ensaio experimental foi conduzido em uma coluna de acrílico de 35cm de diâmetro interno e 105cm de comprimento preenchida com terra fina seca ao ar. A técnica da TDR possibilitou a obtenção de uma malha espaço-temporal em curtos intervalos de tempo e da umidade e da condutividade elétrica (Ce) nas diferentes profundidades consideradas. Tal resultado pode trazer uma importante contribuição para o entendimento da dinâmica da água e do potássio na terra, auxiliando os trabalhos para proposição e validação de modelos matemáticos que descrevem numericamente esses processos.

---

The aim of this research was to evaluate the advantages of using unsaturated soil columns equipped with TDR probes (Time Domain Reflectometry) coupled to an automated system of data acquisition for monitoring water and potassium movement in soils. The research was conducted in acrylic columns of 0.35m of internal diameter and 1.05m of length filled with air-dried soil. The use of TDR technique allowed obtaining time-space network at short time intervals, indicating levels of soil moisture and electric conductivity (Ce) at different depths. The results may represent an important help for the works on the proposition and validation of mathematical models that describe numerically these processes, contributing to a better understanding of the dynamics of water and potassium in soils.