RESUMO
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.
Assuntos
Hiperfosfatemia/terapia , Falência Renal Crônica/terapia , Fosfatos/sangue , Diálise Renal/instrumentação , Diálise Renal/métodos , Adulto , Creatinina/sangue , Soluções para Diálise/uso terapêutico , Feminino , Humanos , Hiperfosfatemia/sangue , Falência Renal Crônica/sangue , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Ureia/sangue , Uremia/sangue , Uremia/terapiaRESUMO
This study reports the 25-year experience of a single university center with respect to the impact of selected variables on long-term survival and half-life of 742 transplants. We calculated 1-, 5-, and 10-year Kaplan-Meier survival rates for grafts and patients, with separate analyses for HLA match and for each quinquennium. We also investigated the impact of cyclosporine administration and OKT3 induction. Global graft and patient survival rates were 85.2%, 61.0%, and 43.5% and 93.0%, 78.9%, and 66.6% for 1, 5, and 10 years, respectively. The half-life of 23.3 years for the 105 HLA-identical transplants was significantly better (P <.0001) than that for all other matches. Half-lives for 319 1-haplotype matched, 116 living-unrelated, and 153 cadaver grafts were 8.2, 5.7, and 5.6 years, respectively. No survival advantage was noted among these other matches. Introduction of cyclosporine in all non HLA-identical transplants and OKT3 induction for cadaver grafts conferred significant survival advantages compared with no use (P =.0002 and P =.009). There has been a continuous improvement in the long-term results in each quinquennium studied.
Assuntos
Sobrevivência de Enxerto/imunologia , Transplante de Rim/estatística & dados numéricos , Brasil , Seguimentos , Teste de Histocompatibilidade , Hospitais Universitários , Humanos , Transplante de Rim/imunologia , Transplante de Rim/mortalidade , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
The effects of NaCl 0.9%, Ringer-acetate, and Ringer-dextran given as intravenous infusions in the microcirculatory changes observed in early stages of endotoxemia were investigated in male hamsters treated with Escherichia coli lipopolysaccharide (LPS). The cheek pouch was studied in vivo by means of intravital microscopy. Mean arterial (MAP) and venous pressures (CVP), heart rate, mean arteriolar internal diameter, spontaneous arteriolar vasomotion (AV), red blood cell velocity (RBCV) in these vessels, and long-term effects of LPS were evaluated in animals treated with either LPS alone or the combination of LPS with NaCl 0.9%, Ringer-acetate and Ringer-dextran. The intravenous injection of LPS (0.3 mg/kg) elicited a significant reduction in MAP and CVP, cessation of AV and a decrease in RBCV. In our study, the heart rate and the arteriolar diameter did not change significantly, compared with the control values obtained before the LPS injection. No improvement in the MAP could be detected with infusions of NaCl 0.9% or Ringer-acetate but the infusion of Ringer-dextran increased it significantly. All infusions tested maintained the CVP until the end of the observation period and the Ringer-dextran increased it significantly. The heart rate was maintained around 360 beats/min with a tendency to decrease 70 min after the LPS infusion in all groups studied except the group which received NaCl 0.9% where the heart rate decreased significantly. In all the four groups, the mean arteriolar diameter did not change significantly with time during the observed period. RBCV decrease with the combination LPS + NaCl 0.9% and the infusions of Ringer-acetate and Ringer-dextran maintained it until the end of the observation period. The combination of LPS + NaCl 0.9% maintained the spontaneous arteriolar vasomotion during 50 min after LPS injection and the infusion of Ringer-acetate maintained it for the 3-h observation period. The infusion of Ringer-dextran maintained the amplitude of the spontaneous arteriolar vasomotion and increased its frequency significantly. The long-term effects of LPS showed weight loss and pus on the periorbital area. Our results suggest that the best solution to maintain the microcirculatory parameters during the early stage of endotoxemia after LPS injection was the Ringer-dextran.
Assuntos
Bochecha/irrigação sanguínea , Dextranos/farmacologia , Soluções Isotônicas/farmacologia , Lipopolissacarídeos/toxicidade , Animais , Arteríolas/anatomia & histologia , Arteríolas/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Cricetinae , Modelos Animais de Doenças , Edema/tratamento farmacológico , Eritrócitos/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Masculino , Mesocricetus , Microcirculação/efeitos dos fármacos , Solução de Ringer , Redução de PesoRESUMO
With the aim to study potential risk factors for the development of microalbuminuria and retinopathy, baseline characteristics were examined in 50 Brazilian IDDM patients followed for 4.48 years with a 2-year reexamination. During the study, 3 patients (6%) aged 25.9 +/- 4.4 years, duration of diabetes 8.1 +/- 4.2 years, died from acute complications without microalbuminuria and retinopathy after a follow-up of 2.1 +/- 0.7 years. The standardized mortality rate for the group was 0.84 per 1000 (95% CL, 0.31, 1.83) in comparison to 0.14 per 1000 in the general population. From 34 normoalbuminuric individuals at baseline (urinary albumin excretion rate (AER) < or = 20 micrograms/min in > or = 2 overnight urine collections), 10 developed microalbuminuria with an incidence density of 6.5 cases per 100 person-years (95% CL, 2.23, 10.16). Spontaneous normalization of AER was found in 2 of 4 patients with microalbuminuria at cycle 2. Multiple stepwise regression analysis demonstrated that baseline AER (p = 0.03), but not glycated hemoglobin, blood pressure or duration of diabetes, predicted end-of-study AER. From 36 patients without retinopathy, 10 developed nonproliferative retinopathy with an incidence density of 6.6 cases per 100 person-years (95% CL, 2.75, 10.54). Retinopathy was associated with duration (p = 0.05) and age at diagnosis of diabetes (p = 0.01). A tendency with baseline AER (p = 0.06) was also noted. No patient developed macroalbuminuria, proliferative retinopathy or hypertension. By the end of our study, in a cohort of young IDDM patients followed in a developing country, 6% died from acute complications and 15 patients (44.1%) developed retinopathy and/or microalbuminuria. Our results suggest that the only predictor of end-of-study AER was baseline AER. Also, duration of diabetes and age at diagnosis appear to be risk factors for retinopathy.
Assuntos
Albuminúria/epidemiologia , Diabetes Mellitus Tipo 1/fisiopatologia , Retinopatia Diabética/epidemiologia , Adulto , Pressão Sanguínea , Brasil/epidemiologia , Estudos de Coortes , Diabetes Mellitus Tipo 1/mortalidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Fatores de RiscoRESUMO
PURPOSE: To determine the relationship among clinical data, attenuated treadmill stress test (ST), cinecoronaryarteriography (CINE), ejection fraction (EF) with early-late mortality in patients after acute myocardial infarction (AMI). METHODS: Prospective study in 96 consecutive patients aged < 70 with AMI that were submitted to ST and CINE. Assessment of cardiac mortality was made 1-3 years post-AMI (period I) and at the end of follow-up (7-10 years-period II). RESULTS: First year and 10th year mortalities were 8% and 36%, respectively. Positive predictive value for cardiac death in period I was 10% for ST, 7% for multivessel coronary artery disease (MVCAD) and 9% for left ventricular ejection fraction (LVEF) < 30, while in period II they were 45%, 42% and 50%, respectively. Actuarial survival analysis (Kaplan-Meyer) disclosed mortality rates of 53% and 20% (p = 0.06) on period II for positive and negative ST, respectively, 45% and 22% (p < 0.03) for MVCAD and single-vessel disease, respectively, and 73% and 35% (p < 0.001) for those with and without left main coronary artery obstruction, respectively. In the multivariate regression analysis (Cox's model), only MVCAD (p < 0.002), LVEF < 30 (p < 0.003), positive ST (p < 0.007) and post-AMI angina (p < 0.01) were independently related to late mortality. CONCLUSION: Both attenuated ST and CINE are poor predictors of post-AMI early and late mortalities. However, multivariate regression analysis disclosed positive ST, MVCAD and LVEF < 30 as independent variables related to late mortality. This data indicate that myocardial ischemia, number of obstructed coronary arteries and poor left ventricular systolic function are the true determinants of post-infarction cardiac mortality.