RESUMEN
A strong rationale supports the development of adsorption-based extracorporeal blood purification in conditions such as sepsis, acute kidney disease, uremia, and acute liver failure. The retention of compounds as a consequence of acute or chronic organ dysfunction might have detrimental effects. When a causative effect of an accumulated compound in a pathogenic condition is demonstrated, a rationale for the removal of this solute is also established. Adsorption is a mass transfer mechanism in which a solute chemically interacts with the surface of a solid structure (sorbent) and is removed from its solvent (i.e., blood or plasma). Traditional extracorporeal blood purification techniques utilize semipermeable membranes and depend mainly on diffusion and convection as mechanisms of mass transfer. Protein-bound solutes and water-soluble compounds with molecular weight above 25 kDa are scantly removed by either diffusive or convective clearances. In contrast, recently developed resins have demonstrated safety aligned with notable adsorptive capability, which enables the extraction of endotoxins, inflammatory mediators, and uremic toxins. The understanding of the kinetics of these elements and the improvement in patient selection are key factors to propel exploratory and confirmatory trials that ultimately will lead to the expected changes in clinical practice.
Asunto(s)
Sepsis , Uremia , Humanos , Adsorción , Uremia/terapia , Agua , Endotoxinas , Diálisis Renal/métodosRESUMEN
BACKGROUND: Anemia is one of the most frequent complications in patients with chronic kidney disease (CKD). Despite being multifactorial, the relative or absolute deficiency of erythropoietin production is the leading cause. Recent studies have shown that uremic toxins produced by the gut microbiota also may play a role in the genesis of anemia in these patients. OBJECTIVE: To evaluate the possible association between uremic toxins plasma levels and anemia in patients with CKD on hemodialysis (HD). METHODS: This cross-sectional study evaluated one hundred fifty-four patients (53.2% men, 51.2 ± 11.2 years, hemoglobin (Hb) levels of 11.2 ± 1.6 g/dL). Biochemical variables such as urea, creatinine, hemoglobin, hematocrit, were measured according to standard methods and uremic toxins such as indoxyl sulfate (IS), indole-3-acetic acid (IAA), p-cresyl sulfate (p-CS) plasma levels were measured by reverse-phase high-performance liquid chromatography (RP-HPLC). RESULTS: The levels of uremic toxins such as IS, IAA, p-CS were increased in all patients. However, no correlation was found between uremic toxins plasma levels and anemia parameters. Only patients with Hb < 11 g/dL presented a negative correlation between hematocrit and IAA plasma levels. CONCLUSION: There is no strong evidence that uremic toxins produced by the gut microbiota may be associated with anemia in patients with CKD on HD.
Asunto(s)
Anemia , Microbioma Gastrointestinal , Insuficiencia Renal Crónica , Uremia , Anemia/complicaciones , Estudios Transversales , Femenino , Humanos , Indicán , Masculino , Diálisis Renal/efectos adversos , Diálisis Renal/métodos , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapia , Uremia/complicaciones , Uremia/terapia , Tóxinas UrémicasRESUMEN
Although the clearance of low-molecular weight toxins is modulated by dialysis dose, the relationship between dialysis adequacy and middle systemic inflammatory mediators is often overlooked. Thus, the relationship between dialysis adequacy, pro- and anti-inflammatory cytokines and chemokines in hemodialysis (HD) patients was investigated. Forty-eight HD patients (19 women and 25 men) were investigated. Age, body mass index, time in HD, nutritional status, Kt/V and blood biochemical parameters was similar in patients of both sexes (P > 0.05). Thus, patients were stratified by dialysis adequacy measured by Kt/V method (adequate Kt/V ≥ 1.2). Post-HD urea, creatinine, cytokines (IFN-γ, IL-4 and IL-10) and chemokines (CCL-2, CCL-5, CXCL-8 and CXCL-10) were higher in patients with Kt/V < 1.2 (P < 0.05). Kt/V exhibited significant correlation with CXCL-10/IP-10 serum levels. Positive correlation between creatinine with IFN-γ, CCL-2/MCP-1, and CXCL-10/IP-10, and negative correlation with IL-10 was identified in patients with Kt/V < 1.2 (P < 0.05). In patients with Kt/V ≥ 1.2, only IL-10 was positively and CXCL-10/IP-10 negatively correlated with creatinine levels (P < 0.05). Kt/V and creatinine levels exhibited variable predictive value (Kt/V = 27% to 37%, creatinine = 29% to 47%) to explain cytokines and chemokines circulating levels in patients with adequate and inadequate dialysis dose. Taken together, our findings provide evidence that in addition to modulating uremic toxins levels, such as urea and creatinine, dialysis dose is associated with circulating levels of inflammatory mediators. Thus, low Kt/V results and creatinine accumulation are potential indicators of the systemic inflammatory stress determined by up-regulation of proinflammatory cytokines and chemokines, and downregulation of anti-inflammatory cytokines.
Asunto(s)
Quimiocina CXCL10/sangre , Creatinina/sangre , Inflamación/sangre , Interleucina-10/sangre , Fallo Renal Crónico/terapia , Diálisis Renal , Uremia/terapia , Adulto , Anciano , Biomarcadores/sangre , Femenino , Humanos , Inflamación/diagnóstico , Fallo Renal Crónico/sangre , Fallo Renal Crónico/diagnóstico , Masculino , Persona de Mediana Edad , Diálisis Renal/efectos adversos , Resultado del Tratamiento , Uremia/sangre , Uremia/diagnóstico , Adulto JovenRESUMEN
INTRODUCTION: Peripheral neuropathy is a disorder that affects the cell body, axon or myelin of motor or peripheral sensory neurons and occurs in 60-100% of patients who are submitted to dialysis due to chronic kidney disease. Uremic neuropathy (UN) is attributed to the accumulation of organic waste, evident in patients with reduced glomerular filtration rate. OBJECTIVES: This review aims to make clinical characteristics of uremic neuropathy evident enabling early diagnosis and treatment. METHODS: This is a literature review of articles published on PubMed over the last 10 years using "Uremic Neuropathy" as "Title/Abstract". RESULTS: A total of nine articles that met the inclusion criteria were included. UN is a distal symmetric sensorimotor polyneuropathy that occurs due to the accumulation of uremic toxins associated with an oxidative stress-related free radical activity. Hyperkalemia is thought to play an important role in its pathophysiology. Diagnosis depends on nerve conduction studies, and treatment includes dialysis or renal transplant. CONCLUSION: Clinical presentations of UN are broad and non-specific; nonetheless, it is important to detect early changes in order to avoid its progression. The earlier UN is diagnosed and treated, the more successful are the clinical outcomes.
Asunto(s)
Polineuropatías/patología , Uremia/patología , Humanos , Trasplante de Riñón , Polineuropatías/diagnóstico , Polineuropatías/terapia , Diálisis Renal , Factores de Riesgo , Uremia/diagnóstico , Uremia/terapiaRESUMEN
INTRODUCTION: Peripheral neuropathy is a disorder that affects the cell body, axon or myelin of motor or peripheral sensory neurons and occurs in 60-100% of patients who are submitted to dialysis due to chronic kidney disease. Uremic neuropathy is attributed to the accumulation of organic waste, evident in patients with reduced glomerular filtration rate. OBJECTIVES: This review aims to make clinical characteristics of uremic neuropathy evident enabling early diagnosis and treatment. METHODS: This is a literature review of articles published on PubMed over the last 10 years using "Uremic Neuropathy" as "Title/Abstract". RESULTS: A total of nine articles that met the inclusion criteria were included. UN is a distal symmetric sensorimotor polyneuropathy that occurs due to the accumulation of uremic toxins associated with an oxidative stress-related free radical activity. Hyperkalemia is thought to play an important role in its pathophysiology. Diagnosis depends on nerve conduction studies, and treatment includes dialysis or renal transplant. CONCLUSION: Clinical presentations of UN are broad and non-specific; nonetheless, it is important to detect early changes in order to avoid its progression. The earlier UN is diagnosed and treated, the more successful are the clinical outcomes.
Asunto(s)
Enfermedades del Sistema Nervioso Periférico , Uremia , Humanos , Trasplante de Riñón , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Enfermedades del Sistema Nervioso Periférico/terapia , Diálisis Renal , Uremia/diagnóstico , Uremia/fisiopatología , Uremia/terapiaRESUMEN
BACKGROUND AND OBJECTIVES: Current hemodialysis techniques fail to efficiently remove the protein-bound uremic toxins p-cresyl sulfate and indoxyl sulfate due to their high degree of albumin binding. Ibuprofen, which shares the same primary albumin binding site with p-cresyl sulfate and indoxyl sulfate, can be infused during hemodialysis to displace these toxins, thereby augmenting their removal. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We infused 800 mg ibuprofen into the arterial bloodline between minutes 21 and 40 of a conventional 4-hour high-flux hemodialysis treatment. We measured arterial, venous, and dialysate outlet concentrations of indoxyl sulfate, p-cresyl sulfate, tryptophan, ibuprofen, urea, and creatinine before, during, and after the ibuprofen infusion. We report clearances of p-cresyl sulfate and indoxyl sulfate before and during ibuprofen infusion and dialysate concentrations of protein-bound uremic toxins normalized to each patient's average preinfusion concentrations. RESULTS: We studied 18 patients on maintenance hemodialysis: age 36±11 years old, ten women, and mean vintage of 37±37 months. Compared with during the preinfusion period, the median (interquartile range) clearances of indoxyl sulfate and p-cresyl sulfate increased during ibuprofen infusion from 6.0 (6.5) to 20.2 (27.1) ml/min and from 4.4 (6.7) to 14.9 (27.1) ml/min (each P<0.001), respectively. Relative median (interquartile range) protein-bound uremic toxin dialysate outlet levels increased from preinfusion 1.0 (reference) to 2.4 (1.2) for indoxyl sulfate and to 2.4 (1.0) for p-cresyl sulfate (each P<0.001). Although median serum post- and predialyzer levels in the preinfusion period were similar, infusion led to a marked drop in serum postdialyzer levels for both indoxyl sulfate and p-cresyl sulfate (-1.0 and -0.3 mg/dl, respectively; each P<0.001). The removal of the nonprotein-bound solutes creatinine and urea was not increased by the ibuprofen infusion. CONCLUSIONS: Infusion of ibuprofen into the arterial bloodline during hemodialysis significantly increases the dialytic removal of indoxyl sulfate and p-cresyl sulfate and thereby, leads to greater reduction in their serum levels.
Asunto(s)
Cresoles/sangre , Ibuprofeno/administración & dosificación , Indicán/sangre , Diálisis Renal , Albúmina Sérica Humana/metabolismo , Ésteres del Ácido Sulfúrico/sangre , Uremia/terapia , Adulto , Unión Competitiva , Femenino , Humanos , Ibuprofeno/efectos adversos , Ibuprofeno/sangre , Infusiones Intraarteriales , Masculino , Persona de Mediana Edad , Unión Proteica , Diálisis Renal/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Uremia/sangre , Uremia/diagnósticoRESUMEN
SUMMARY INTRODUCTION: Peripheral neuropathy is a disorder that affects the cell body, axon or myelin of motor or peripheral sensory neurons and occurs in 60-100% of patients who are submitted to dialysis due to chronic kidney disease. Uremic neuropathy is attributed to the accumulation of organic waste, evident in patients with reduced glomerular filtration rate. Objectives: This review aims to make clinical characteristics of uremic neuropathy evident enabling early diagnosis and treatment. Methods: This is a literature review of articles published on PubMed over the last 10 years using "Uremic Neuropathy" as "Title/Abstract". Results: A total of nine articles that met the inclusion criteria were included. UN is a distal symmetric sensorimotor polyneuropathy that occurs due to the accumulation of uremic toxins associated with an oxidative stress-related free radical activity. Hyperkalemia is thought to play an important role in its pathophysiology. Diagnosis depends on nerve conduction studies, and treatment includes dialysis or renal transplant. Conclusion: Clinical presentations of UN are broad and non-specific; nonetheless, it is important to detect early changes in order to avoid its progression. The earlier UN is diagnosed and treated, the more successful are the clinical outcomes.
RESUMO INTRODUÇÃO: A neuropatia periférica (NU) é um distúrbio que afeta o corpo celular, o axônio ou a mielina do motor ou neurônios sensoriais periféricos e ocorre em 60%-100% dos pacientes que são submetidos à diálise por doença renal crônica. A neuropatia urêmica é atribuída à acumulação de resíduos orgânicos, evidente em pacientes com taxa de filtração glomerular reduzida. Objetivo: O objetivo desta revisão é fazer com que as características clínicas da neuropatia urêmica sejam evidenciadas, permitindo o diagnóstico e tratamento precoce. Método: Esta é uma revisão da literatura de artigos publicados no PubMed nos últimos dez anos usando "Neuropatia Urêmica" como "Título/Resumo". Resultados: No total, foram incluídos nove artigos que atendem aos critérios de inclusão. A NU é uma polineuropatia sensório-motora simétrica distal que ocorre devido ao acúmulo de toxinas urêmicas associadas à atividade de radicais livres relacionados ao estresse oxidativo. A hipercalemia tem um papel importante na sua fisiopatologia. O diagnóstico depende de estudos de condução nervosa e o tratamento inclui diálise ou transplante renal. Conclusão: As apresentações clínicas das NU são amplas e não específicas; no entanto, é importante detectar mudanças iniciais para evitar sua progressão. Quanto mais precoce for a detecção e tratamento da NU, melhor será o resultado clínico.
Asunto(s)
Humanos , Uremia/diagnóstico , Uremia/fisiopatología , Uremia/terapia , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Enfermedades del Sistema Nervioso Periférico/terapia , Diálisis Renal , Trasplante de RiñónRESUMEN
Pregnancy is a physiological process that brings many changes to the mother's body, undergoing a process of adaptation to complications avoid, however, in the context of chronic kidney disease, these become manifest most frequently maternal and fetal impact on morbidity and mortality. A review of the subject is presented, emphasizing aspects that must be present at the time of a patient with this condition, accompanied by one of our cases treated with the sole purpose of gaining a better understanding of the issue and how to address it based on problems at the time of evaluation initial. The case of patient pregnant with chronic kidney disease in stage advanced that required start of replacement therapy in renal function due to uremia and retention fluid in malaise their 20 weeks of gestation, referred late for your attention. However, it was possible to improve you overall condition in all respects, allowing take up to 38 weeks with abdominal delivery via scheduled electively, with favorable results for the newborn exceed the statistics described in these patients.
Asunto(s)
Complicaciones del Embarazo/fisiopatología , Resultado del Embarazo , Insuficiencia Renal Crónica/complicaciones , Terapia de Reemplazo Renal/métodos , Femenino , Humanos , Recién Nacido , Embarazo , Complicaciones del Embarazo/terapia , Insuficiencia Renal Crónica/terapia , Uremia/etiología , Uremia/terapia , Adulto JovenRESUMEN
INTRODUCTION: Endothelial dysfunction is important in the pathogenesis of cardiovascular disease (CVD) related to chronic kidney disease (CKD). Stromal cell-derived factor-1 (SDF-1) is a chemokine which mobilizes endothelial progenitor cells (EPC) and together with interleukin-8 (IL-8) may be used as markers of tissue injury and repair. OBJECTIVE: This study investigated in vivo and in vitro the effect of uremic media on SDF-1 and IL-8 expression. METHODS: Systemic inflammation was assessed by C-reactive protein (CRP) and interleukin-6 (IL-6). IL-8 and SDF-1 were measured as markers of endothelial dysfunction and tissue repair, respectively, by ELISA. In vitro studies were performed on human umbilical vein endothelial cells (HUVEC) exposed to healthy or uremic media. RESULTS: The study included 26 hemodialysis (HD) patients (17 ± 3 months on dialysis, 52 ± 2 years, 38% men and 11% diabetic). Serum concentrations of CRP, IL-6, SDF-1 and IL-8 were 4.9 ± 4.8 mg/ml, 6.7 ± 8.1 pg/ml, 2625.9 ± 1288.6 pg/ml and 128.2 ± 206.2 pg/ml, respectively. There was a positive correlation between CRP and IL-6 (ρ = 0.57, p < 0.005) and between SDF-1 and IL-8 (ρ = 0.45, p < 0.05). In vitro results showed that after 6 hours treatment, SDF-1 expression by HUVEC treated with uremic media is lower compared to cells treated with healthy media (p < 0.05). After 12 hours of treatment there was an increase in IL-8 when HUVECs were exposed to uremic media (p < 0.005). CONCLUSION: We suggest that SDF-1 and IL-8 in HD patients can be used to measure the extent of damage and subsequent vascular activation in uremia.
Asunto(s)
Quimiocina CXCL12/biosíntesis , Interleucina-8/biosíntesis , Fallo Renal Crónico/sangre , Uremia/sangre , Fenómenos Fisiológicos Sanguíneos , Células Cultivadas , Endotelio Vascular/citología , Endotelio Vascular/metabolismo , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Diálisis Renal , Uremia/terapiaRESUMEN
Introdução: A disfunção endotelial é importante na patogênese da doença cardiovascular (DCV) relacionada à doença renal crônica (DRC). Stromal cell-derived factor-1 (SDF-1) é uma quimiocina que mobiliza células endoteliais progenitoras (EPC) e em conjunto com a interleucina-8 (IL-8) podem ser usadas como marcadores de reparo e lesão tecidual. Objetivo: Neste trabalho, foi investigado o efeito do meio urêmico na expressão de SDF-1 e IL-8 in vivo e in vitro. Métodos: A inflamação sistêmica foi avaliada por meio da proteína C-reativa (PCR) e interleucina-6 (IL-6). IL-8 e SDF-1 foram avaliados por ELISA como marcadores de disfunção endotelial e reparo tecidual, respectivamente. Os estudos in vitro foram realizados em células endoteliais umbilicais humanas (HUVEC) expostas ao meio urêmico ou saudável. Resultados: Foram incluídos nesse estudo 26 pacientes em hemodiálise (HD) (17 ± 3 meses em diálise, 52 ± 2 anos, 38% homens e 11% diabéticos). As concentrações séricas de PCR, IL-6, SDF-1 e IL-8 foram 4,9 ± 4,8 mg/ml, 6,7 ± 8,1 pg/ml, 2625,9 ± 1288,6 pg/ml e 128,2 ± 206,2 pg/ml, respectivamente. Houve correlação positiva entre PCR e IL-6 (ρ = 0,57; p < 0,005) e entre SDF-1 e IL-8 (ρ = 0,45; p < 0,05). Os resultados in vitro demonstraram que a expressão de SDF-1 pelas HUVEC após 6 horas de tratamento com meio urêmico é menor comparada ao tratamento com meio saudável (p < 0,05). Após 12 horas de tratamento, ocorreu aumento de IL-8 quando as HUVECs foram expostas ao meio urêmico (p < 0,005). Conclusão: Sugerimos que SDF-1 e IL-8 nos pacientes em HD podem ser usados para mensurar a extensão do dano e consequente ativação vascular na uremia. .
Introduction: Endothelial dysfunction is important in the pathogenesis of cardiovascular disease (CVD) related to chronic kidney disease (CKD). Stromal cell-derived factor-1 (SDF-1) is a chemokine which mobilizes endothelial progenitor cells (EPC) and together with interleukin-8 (IL-8) may be used as markers of tissue injury and repair. Objective: This study investigated in vivo and in vitro the effect of uremic media on SDF-1 and IL-8 expression. Methods: Systemic inflammation was assessed by C-reactive protein (CRP) and interleukin-6 (IL-6). IL-8 and SDF-1 were measured as markers of endothelial dysfunction and tissue repair, respectively, by ELISA. In vitro studies were performed on human umbilical vein endothelial cells (HUVEC) exposed to healthy or uremic media. Results: The study included 26 hemodialysis (HD) patients (17 ± 3 months on dialysis, 52 ± 2 years, 38% men and 11% diabetic). Serum concentrations of CRP, IL-6, SDF-1 and IL-8 were 4.9 ± 4.8 mg/ml, 6.7 ± 8.1 pg/ml, 2625.9 ± 1288.6 pg/ml and 128.2 ± 206.2 pg/ml, respectively. There was a positive correlation between CRP and IL-6 (ρ = 0.57, p < 0.005) and between SDF-1 and IL-8 (ρ = 0.45, p < 0.05). In vitro results showed that after 6 hours treatment, SDF-1 expression by HUVEC treated with uremic media is lower compared to cells treated with healthy media (p < 0.05). After 12 hours of treatment there was an increase in IL-8 when HUVECs were exposed to uremic media (p < 0.005). Conclusion: We suggest that SDF-1 and IL-8 in HD patients can be used to measure the extent of damage and subsequent vascular activation in uremia. .
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , /biosíntesis , /biosíntesis , Fallo Renal Crónico/sangre , Uremia/sangre , Fenómenos Fisiológicos Sanguíneos , Células Cultivadas , Endotelio Vascular/citología , Endotelio Vascular/metabolismo , Fallo Renal Crónico/terapia , Diálisis Renal , Uremia/terapiaRESUMEN
Autogenous arteriovenous fistula (AVF) is the first choice for hemodialysis access in renal failure with uremia. However, AVF cannot be performed in some patients due to small and narrow veins in the forearm. In this study, a Fogarty catheter was used to establish autogenous radiocephalic hemodialysis access in patients with small caliber cephalic veins, and the patency rate and complications of this method were observed. Sixty-seven patients with uremia were divided into a treatment group (40 cases, caliber of cephalic veins<2.5 mm) and a control group (27 cases, caliber of cephalic veins≥2.5 mm). According to ultrasound results, the treatment group received AVF after expansion with a Fogarty catheter, and the control group received traditional AVF. The fistula patency rate and complications were observed during follow-up. All patients were followed up for an average period of 18 months (range=3-36 months). AVF was successfully used in 58 patients for hemodialysis, with primary access failure in 9 cases (5 cases in the treatment group and 4 cases in the control group) due to early thrombosis. The primary and secondary patency rates 12 months after surgery in the treatment group were 64 and 72%, respectively, and those in the control group were 60 and 76%, respectively. Patients with small caliber cephalic veins can be treated with radiocephalic fistula after the caliber of cephalic veins is expanded to more than 2.5 mm with a Fogarty catheter. The long-term patency rate awaits observation in a longer follow-up period.
Asunto(s)
Embolectomía con Balón/métodos , Diálisis Renal/métodos , Uremia/terapia , Venas/anatomía & histología , Adulto , Anciano , Fístula Arteriovenosa , Femenino , Antebrazo/anatomía & histología , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Uremia/patologíaRESUMEN
INTRODUCTION: Uremic pruritus is common among dialysis patients. Effective treatments are not readily available. Early evidence with antihistamines and gabapentin indicate variable effects. OBJECTIVE: To compare the efficacy and side effects of gabapentin and desloratadine in patients with dialysis pruritus. METHODS: Prospective, open-label, cross-over clinical trial in 22 patients on chronic hemodialysis with sustained pruritus over a period of at least 60 days. After a one-week run-in period, we assigned patients to three weeks of either gabapentin 300 mg thrice weekly or desloratadine 5 mg thrice weekly. After a one-week washout period, each patient crossed-over to the alternate regimen for three more weeks. The primary endpoint of the study was the change in the visual analogue pruritus score (VAS). RESULTS: Nineteen subjects completed the two treatment blocks and were available for analysis. VAS scores decreased with both treatments (5.95 to 4.6 with gabapentin, p = 0.07; 5.89 to 3.4 with desloratadine, p = 0.004), but only desloratadine reached statistical significance. There were no differences when comparing the final pruritus score with gabapentin and desloratadine (4.6 versus 3.4, p = 0.16) Excessive sedation was common with gabapentin. Desloratadine was well tolerated. CONCLUSION: Desloratadine provides significant relief of uremic pruritus compared with no therapy. gabapentin has marginal efficacy. Desloratadine is better tolerated than gabapentin.
Asunto(s)
Aminas/uso terapéutico , Ácidos Ciclohexanocarboxílicos/uso terapéutico , Antagonistas de los Receptores Histamínicos H1 no Sedantes/uso terapéutico , Loratadina/análogos & derivados , Prurito/tratamiento farmacológico , Diálisis Renal , Ácido gamma-Aminobutírico/uso terapéutico , Aminas/efectos adversos , Estudios Cruzados , Ácidos Ciclohexanocarboxílicos/efectos adversos , Gabapentina , Antagonistas de los Receptores Histamínicos H1 no Sedantes/efectos adversos , Humanos , Loratadina/efectos adversos , Loratadina/uso terapéutico , Persona de Mediana Edad , Estudios Prospectivos , Prurito/etiología , Diálisis Renal/efectos adversos , Uremia/complicaciones , Uremia/terapia , Ácido gamma-Aminobutírico/efectos adversosRESUMEN
BACKGROUND AND OBJECTIVES: The control of hyperphosphatemia is an unmet need in dialysis care. Compared to conventional hemodialysis (cHD), extended hemodialysis (eHD) appears to more easily control blood phosphate levels in chronically dialyzed patients. Here, we sought to compare eKT/V-matched cHD and eHD procedures in order to quantify the contribution of dialysis prescription and time in the mass removal of phosphate. METHODS: Eight stable hemodialysis patients with negligible residual renal function underwent cHD and eHD sessions adjusted to provide the same eKT/V(urea). Total dialysate, total and hourly partial dialysate and blood samples were collected for comparison of mass extraction of urea, creatinine, and phosphate. RESULTS: Mean eKT/V(urea) was similar in eHD and cHD (1.30 vs. 1.28, p = nonsignificant). Likewise, mass removal of urea and creatinine during cHD and eHD were not significantly different. Conversely, phosphate mass removal was 40% higher with eHD as compared to cHD (1,219 ± 262 vs. 858 ± 186 mg, p = 0.015). Although hourly mass removal of phosphate was higher during cHD, the prolonged period of lesser but continuous removal was responsible for higher total phosphate elimination during eHD. CONCLUSION: In dialysis sessions matched to provide a similar eKT/V(urea), removal of phosphate increases by 40% when time is extended from 4 to 8 h. Urea-based adequacy models cannot be used to predict the amount of phosphorus removal during hemodialysis.
Asunto(s)
Hiperfosfatemia/terapia , Fallo Renal Crónico/terapia , Fosfatos/sangre , Diálisis Renal/instrumentación , Diálisis Renal/métodos , Adulto , Creatinina/sangre , Soluciones para Diálisis/uso terapéutico , Femenino , Humanos , Hiperfosfatemia/sangre , Fallo Renal Crónico/sangre , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Urea/sangre , Uremia/sangre , Uremia/terapiaRESUMEN
INTRODUCTION: Uremic pruritus is common among dialysis patients. Effective treatments are not readily available. Early evidence with antihistamines and gabapentin indicate variable effects. OBJECTIVE: To compare the efficacy and side effects of gabapentin and desloratadine in patients with dialysis pruritus. METHODS: Prospective, open-label, cross-over clinical trial in 22 patients on chronic hemodialysis with sustained pruritus over a period of at least 60 days. After a one-week run-in period, we assigned patients to three weeks of either gabapentin 300 mg thrice weekly or desloratadine 5 mg thrice weekly. After a one-week washout period, each patient crossed-over to the alternate regimen for three more weeks. The primary endpoint of the study was the change in the visual analogue pruritus score (VAS). RESULTS: Nineteen subjects completed the two treatment blocks and were available for analysis. VAS scores decreased with both treatments (5.95 to 4.6 with gabapentin, p = 0.07; 5.89 to 3.4 with desloratadine, p = 0.004), but only desloratadine reached statistical significance. There were no differences when comparing the final pruritus score with gabapentin and desloratadine (4.6 versus 3.4, p = 0.16) Excessive sedation was common with gabapentin. Desloratadine was well tolerated. CONCLUSION: Desloratadine provides significant relief of uremic pruritus compared with no therapy. gabapentin has marginal efficacy. Desloratadine is better tolerated than gabapentin.
INTRODUÇÃO: Prurido urêmico é comum entre pacientes em diálise. Tratamentos eficazes não estão disponíveis até o momento. Provas recentes com anti-histamínicos e gabapentina indicam vários efeitos. OBJETIVO: Comparar a eficiência e os efeitos colaterais da gabapentina e da desloratadina em pacientes com prurido na diálise. MÉTODOS: Estudo prospectivo, aberto e comparativo com 22 pacientes em hemodiálise crônica com prurido constante durante um período de pelo menos 60 dias. Após uma semana, submetemos os pacientes a três semanas de gabapentina 300 mg, três vezes por semana, ou desloratadina 5 mg três vezes por semana. Após um período de eliminação de uma semana, os pacientes trocaram de regime por mais três semanas. O objetivo primário do estudo foi a mudança na escala visual analógica (EVA) de prurido. RESULTADOS: Dezenove indivíduos completaram os dois tratamentos e foram submetidos à análise. Os escores da EVA caíram com ambos os tratamentos (5,95 para 4,6 com gabapentina, p = 0,07; 5,89 para 3,4 com desloratadina, p = 0,004), mas somente a desloratadina teve significância estatística. Nenhuma diferença foi observada ao comparar o escore final do prurido com gabapentina e desloratadina (4,6 versus 3,4, p = 0,16). Excesso de sedação foi comum com gabapentina. A desloratadina teve alto nível de tolerância. CONCLUSÃO: A desloratadina dá alívio significante do prurido urêmico quando comparada a nenhum tratamento. A gabapentina tem eficiência marginal. A desloratadina tem maior nível de tolerância em relação à gabapentina.
Asunto(s)
Humanos , Persona de Mediana Edad , Aminas/uso terapéutico , Ácidos Ciclohexanocarboxílicos/uso terapéutico , Antagonistas de los Receptores Histamínicos H1 no Sedantes/uso terapéutico , Loratadina/análogos & derivados , Prurito/tratamiento farmacológico , Diálisis Renal , Ácido gamma-Aminobutírico/uso terapéutico , Aminas/efectos adversos , Estudios Cruzados , Ácidos Ciclohexanocarboxílicos/efectos adversos , Antagonistas de los Receptores Histamínicos H1 no Sedantes/efectos adversos , Loratadina/efectos adversos , Loratadina/uso terapéutico , Estudios Prospectivos , Prurito/etiología , Diálisis Renal/efectos adversos , Uremia/complicaciones , Uremia/terapia , Ácido gamma-Aminobutírico/efectos adversosRESUMEN
BACKGROUND: Patients with chronic kidney disease (CKD) on regular hemodialysis are at increased risk of acquiring hepatitis C virus (HCV). Although controversial, a distinct dynamic of the HCV load has been reported in this group - a lower HCV viremia compared to non-uremic patients. The reasons for this remain unclear, but the host immune response related to the hemodialysis procedure and the reuse of dialysis membranes are the most investigated factors. METHODS: We analyzed the kinetics of HCV RNA viremia in 21 hemodialysis patients infected with genotype 1, through a highly sensitive quantitative method (real-time polymerase chain reaction), immediately before and at the end of the first use and the last reuse of the cellulose diacetate dialysis membrane. RESULTS: Initial HCV load did not correlate with demographic or biochemical parameters, but higher HCV viremia was associated with a longer time on hemodialysis (r = 0.44, p = 0.04). Although not significant, HCV RNA decreased in 11/21 (52.3%) patients after the first dialysis session (median 279,000 vs 176,000 IU/ml, p = 0.91). However, a significant increase in HCV RNA viremia was observed in 17/21 (80.9%) patients after the tenth session (median 187,000 vs 342,000 IU/ml, p = 0.009). CONCLUSIONS: Except for the first session of hemodialysis, we did not confirm a decrease in HCV viremia related to the time on hemodialysis or with the reuse of the dialysis membrane. Factors other than the reuse of the dialysis membrane might be involved in the multifaceted kinetics of HCV RNA in CKD patients on hemodialysis.
Asunto(s)
Hepacivirus/aislamiento & purificación , Hepatitis C/virología , Diálisis Renal , Uremia/terapia , Carga Viral , Viremia , Adulto , Anciano , Femenino , Hepatitis C/complicaciones , Humanos , Masculino , Persona de Mediana Edad , ARN Viral/sangre , Reacción en Cadena en Tiempo Real de la Polimerasa , Uremia/complicacionesRESUMEN
This is the case of a 32 year-old-male with chronic kidney disease in hemodialysis who presented with uncontrolled blood pressure after admission to the hospital further complicated with seizures. Head CT-Scan revealed hypodensives areas in sub-cortical white matter and parietal-occipital lobes. Posterior reversible leukoencephalopathy syndrome (PRES) was diagnosed by radiologic findings. The underlying cause of PRES was treated with good resolution of hypodensives areas. Good prognostic outcome of PRES depends on prompt recognition and treatment to avoid excessive morbidity and/or mortality.
Asunto(s)
Hipertensión/complicaciones , Síndrome de Leucoencefalopatía Posterior/etiología , Convulsiones/etiología , Uremia/complicaciones , Adulto , Edema Encefálico/etiología , Urgencias Médicas , Infecciones por VIH/complicaciones , Hemianopsia/etiología , Hepatitis Viral Humana/complicaciones , Humanos , Angiografía por Resonancia Magnética , Masculino , Síndrome de Leucoencefalopatía Posterior/diagnóstico , Síndrome de Leucoencefalopatía Posterior/patología , Diálisis Renal , Abuso de Sustancias por Vía Intravenosa/complicaciones , Uremia/terapiaRESUMEN
En situaciones de urgencia, la hemodiálisis es la técnica más empleada en pacientes portadores de Insuficiencia Renal Crónica, Insuficiencia Renal Crónica Agudizada y en Insuficiencia Renal Aguda Se realizó un estudio observacional descriptivo de corte transversal. Fueron estudiados todos los pacientes que requirieron hemodiálisis de urgencia en la Unidad de Terapia Intensiva del Instituto de Nefrología Dr. Abelardo Buch, en el período del 1ro. de marzo al 30 de septiembre del 2010, para determinar las causas y para comportamiento de las mismas fueron revisadas todas las historias clínicas y los registros de Enfermería. Se utilizó la técnica estadística de análisis de distribución de frecuencias; absolutas y relativas. De un total de 44 pacientes, predominó el sexo femenino con 54,5 por ciento, la edad mayor de 40 años, 95,5 por ciento, entre 60-69 años, y mayores de 69 años con 25 por ciento respectivamente; la enfermedad de base más frecuente fue la hipertensión arterial. Las causas de indicación de hemodiálisis de urgencia que prevalecieron fueron la hipervolemia (52,2 por ciento) y la hiperazoemia (27,3 por ciento). El 92,9 por ciento de los hemodializados de urgencia no presentaron ninguna complicación durante el proceder. Los resultados expuestos demuestran la experiencia acumulada y calidad de los cuidados que se brindan a estos pacientes en la realización de hemodiálisis de urgencia en nuestro Centro(AU)
All the patients who received urgent hemodialysis at the intensive care unit of the Nephrology Institute Dr Abelardo Buch in the period of March 1st to September 30th 2010 were studied through out an observational descriptive method of transversal cut. Every medical history and nursing register related to these urgent hemodialysis were carefully studied in order to determine the causes that provoked them and their ulterior behavior. It was used the statistical technique of analysis of frequency distributions and the absolute and relative frequencies were calculated. This technique came to show that of 44 patients most of them were female of white race with an age between 40 and 69 years. The most frequent base illness was hypertension. Hypervolemia and Hyperazoemia were the most suggesting causes for urgent hemodialysis. There were not significant complications(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Diálisis Renal/métodos , Insuficiencia Renal/terapia , Tratamiento de Urgencia , Unidades de Cuidados Intensivos , Desequilibrio Ácido-Base/terapia , Desequilibrio Hidroelectrolítico/terapia , Uremia/terapia , Epidemiología Descriptiva , Estudios Transversales , Estudios Observacionales como AsuntoRESUMEN
Chronic dialysis is a valid therapeutic option in very elderly ESRD patients, even though the decision to dialyze or not has little impact on survival. Additionally, very old patients usually do not agree with starting chronic dialysis. Even though, activated charcoal is a cheap treatment for working as adsorbent for nitrogenous products its utility is very limited. We studied the combination of a low protein diet and oral activated charcoal to reduce serum urea and creatinine levels in very old ESRD patients who had refused to start chronic dialysis. Nine lucid, very old > 80 years, ESRD patients who had refused to start dialysis were prescribed a treatment based on a combination of a very low protein diet and oral activated charcoal (30 gram/day). None of the patients had anuria, oliguria, edema, significant metabolic acidosis or hyperkalemia. None of them had significant gastrointestinal symptoms. After one week and ten months of charcoal use significant decrease in blood urea and creatinine levels was observed and none of them required emergency dialysis during this time. In conclusion, in patients more than 80 years of age low protein diet and oral activated charcoal may control the uremic symptoms effectively.
Asunto(s)
Carbón Orgánico/administración & dosificación , Dieta con Restricción de Proteínas , Fallo Renal Crónico/terapia , Administración Oral , Factores de Edad , Anciano de 80 o más Años , Biomarcadores/sangre , Terapia Combinada , Creatinina/sangre , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/dietoterapia , Diálisis Renal , Factores de Tiempo , Resultado del Tratamiento , Negativa del Paciente al Tratamiento , Urea/sangre , Uremia/etiología , Uremia/terapiaRESUMEN
Renal diseases-related metabolic abnormalities cause diverse CNS disturbances, namely uremic encephalopathy, seizures, stroke, movement disorders, sleep alterations, and peripheral nervous system involvement comprising polyneuropathy, mononeuropathies, and myopathy. Some inherited and acquired renal diseases present with concomitant or precedent neurologic syndromes. Several mechanisms involved include toxic metabolic accumulation, hyperkalemia, hypercoagulability, immunologic disturbances, and tubular acido-basic disequilibrium. Clinical symptoms usually indicate severe renal dysfunction, but subtle abnormalities may occur. Judiciously tailored renal replacement therapy may avoid these complications, whereas others may emerge from these very therapies with overlapping clinical pictures. This makes an already complex management of renal patients even more difficult and asks for tight collaboration between nephrologists and neurologists.
Asunto(s)
Enfermedades del Sistema Nervioso Central/complicaciones , Enfermedades Renales/complicaciones , Enfermedades del Sistema Nervioso Periférico/complicaciones , Enfermedades del Sistema Nervioso Central/etiología , Humanos , Enfermedades Renales/terapia , Enfermedades del Sistema Nervioso Periférico/etiología , Terapia de Reemplazo Renal/efectos adversos , Uremia/complicaciones , Uremia/terapiaRESUMEN
Chronic dialysis replacement treatments or renal transplants are instituted when the patient's glomerular filtration rate, measured by 24-h urine endogenous creatinine clearance, is <10-15 ml/mm and, as the The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI), European and Canadian guidelines point out, when one or two of the following complications occur: "uremic toxicity" symptoms, significant fluid retention that does not respond to loop diuretics, hyperkalemia, chronic anemia (hemoglobin <8 g), metabolic acidosis or acute pulmonary edema. In all patients for whom transplant is indicated, a selected live donor must be sought or, in the absence of contraindications, the patient should be registered with the national cadaver donation waiting list. While waiting for the transplant, patients will be on a chronic dialysis program. There is no national registry of patients undergoing chronic dialysis; only indirect data from the Mexican Kidney Foundation and the dialysis industry are available. However, it is estimated that 40,000-50,000 people are under this treatment and the numbers grow by 11% every year. Overall, it is thought that for every patient receiving chronic dialysis, there is one more patient who dies without access to therapy. Hemodialysis units must comply with the Official Hemodialysis Standard and the General Health Council Hemodialysis Unit Quality Assessment Form.