RESUMO
Renal osteodystrophy (ROD) is one of the mostfrequent complications in pediatric uremic patients on peritoneal dialysis (PD), and each case requires a different therapeutic approach. In the present study, we characterized ROD in pediatric patients on chronic PD. We studied 20 patients (12 boys, 8 girls) for a 12-month period. The mean age of the patients was 5.82 +/- 5 years. We allocated each patient to one of three groups according to intact parathormone (iPTH) value: group 1, iPTH < or = 150 pg/mL, n = 12; group 2, iPTH 151 - 400 pg/mL, n = 2; and group 3, iPTH > or = 401 pg/mL, n = 6. Monthly, we recorded plasma calcium, phosphorus, and alkaline phosphatase; Kt/V; normalized protein equivalent of total nitrogen appearance (nPNA); and calcitriol dose. Growth was registered as the Z height/age. Student t-test and analysis of variance for repeated measures were used for the statistical analyses. A value of p < 0.05 was considered significant. All 20 patients completed 6 months of follow-up; 9 patients completed 12 months. At months 1, 6, and 12, vitamin D doses for groups 1 and 3 were significantly different (p < 0.05), as expected. Mean values of iPTH for groups 1 and 3 were 52 +/- 47 pg/mL and 1239 +/- 718 pg/mL respectively, p < 0.05. At 6 months' follow-up, iPTH values had changed to 163 +/- 177 pg/mL for group 1 and 544 +/- 249 pg/mL for group 3 (p < 0.05), butfor group 3 that trend was lost at 12 months' follow-up, when their mean iPTH value rose to 972 +/- 420 pg/mL. Patients who had been started on PD less than 6 months before entering the study (60% of patients) showed a mean iPTH value of 629.13 pg/mL. Patients with more than 6 months on dialysis before entering the study showed an iPTH value of 115.53 pg/mL (p < 0.05). At 6 months' follow-up, iPTH values in groups 1 and 3 both showed a change toward the value range for group 2. At month 12, iPTH values in group 1 continued to show the same tendency, but iPTH values in group 3 showed a tendency to return to their initial levels. Low-turnover ROD was highly prevalent in the study, correlating strongly with time on dialysis.
Assuntos
Distúrbio Mineral e Ósseo na Doença Renal Crônica/tratamento farmacológico , Distúrbio Mineral e Ósseo na Doença Renal Crônica/metabolismo , Diálise Peritoneal , Fosfatase Alcalina/sangue , Calcitriol/uso terapêutico , Cálcio/sangue , Criança , Pré-Escolar , Feminino , Crescimento , Humanos , Lactente , Masculino , Estado Nutricional , Hormônio Paratireóideo/sangue , Fósforo/sangueRESUMO
Se analizan las características epidemiológicas y prevalencia de factores de riesgo en una muestra aleatoria de 111 pacientes ingresados al Hospital Van Buren de Valparaíso entre 1990 y 1992. El 54 por ciento de los ACV ocurrió en mujeres; 55 por ciento fueron de carácter hemorrágico y 18 por ciento fueron en menores de 50 años. La hipertensión arterial estuvo presente en el 71,2 por ciento de los pacientes, 2/3 de los cuales no se controlaban o lo hacían irregularmente; 47,5 por ciento de los pacientes presentaban cardiopatía, siendo más frecuente los trastornos del ritmo. El 19,8 por ciento eran diabéticos y el 28,8 por ciento fumaba; el 13,5 por ciento tenía un hematrocito mayor que 50 y 21,6 por ciento habían sufrido un ACV previo. Sólo dos factores fueron estadísticamente diferentes entre ACV isquémicos y hemorrágicos: la presencia más frecuente de diabetes y cardiopatía entre los primeros (p>0,001). Se concluye en la necesidad de mejorar el control de la hipertensión arterial y de nuevos estudios para explicar los hallazgos encontrados