Diálisis y Trasplante最新文献

Introduction

Dietary intake of processed food with phosphorus-containing additives is increasing. We aimed to compare phosphorus levels in processed foods determined by spectrophotometry and the reported content according to Higher Education Center for Nutrition and Dietetics (CESNID) food composition tables.

Material and methods

We selected 46 products distributed in the following groups: dairy products, cereals, ham and sausage-type meat, refrigerated uncooked meat and poultry, frozen uncooked meat, poultry and fish, and refrigerated or frozen processed products. The presence of phosphate-containing additives was determined by using the nutrition label. The measured phosphorus determined by spectrophotometry was compared with the reported phosphorus recorded in CESNID food composition tables.

Results

Phosphorus content and the phosphorus/protein ratio were higher in products whose nutrition-facts labels indicated phosphate-containing additives. The phosphorus determined by spectrophotometry was usually higher than the phosphorus level in food composition tables. These tables barely reflected the phosphorus content of refrigerated/processed foods.

Conclusions

Information about the phosphorus content of processed foods is generally unavailable, and a disparity between measured (spectrometry) and reported phosphorus (food composition tables) is common. Information and educational programs are essential to make patients with renal disease aware of the existence of foods with phosphate additives. Calls for labeling the content of phosphorus in processed foods are appropriate, and incentives could be provided to process low-phosphorus foods and alternatives to phosphate-containing additives.

Primary –or autonomous– hyperparathyroidism is clinically characterized by the presence of non-pharmacological hypercalcemia with increased or inappropriately normal parathyroid hormone (PTH) levels. We hereby report the case of a 55-year-old woman with chronic kidney disease (CKD) stage 3bA3 who was diagnosed with autonomous hyperparathyroidism. We would like to stress that autonomous hyperparathyroidism is a not infrequent development in CKD patients, that its diagnosis is biochemical and that imaging techniques are only useful to localize hyperfunctioning parathyroid tissue but are not essential for diagnosis. We also review the current surgical criteria and therapeutic alternatives. Among these alternatives, medical treatment with cinacalcet probably deserves special consideration in several patient subgroups that are not candidates for surgery.

Introduction

In Mexico, peritoneal dialysis (PD) is the most widely used dialysis method (60%). Infections of the peritoneum, exit site, and catheter tunnel are frequent, which impairs patients’ quality of life, increases investment costs, shortens the time dialysis can be used, and often requires a switch of dialysis modality. The aim of this study was to evaluate the efficacy and safety of a superoxidized solution (Microdacyn^®) in reducing the frequency of dialysis-associated infections.

Materials and methods

We performed a controlled clinical trial with random allocation. Iodine solution was used in group I (GI) and superoxidized solution in group II (GII). We included incident patients undergoing PD without prior antibiotic therapy. We identified demographic variables, the time of occurrence of the first episode of infection, the clinical characteristics of the infectious process, the causative organisms, and clinical response.

Results

A total of 111 patients were included, 55% men and 45% women, with a mean age of 60.2 years (range: 18-90; SD 14.8), (P>.5). There were 57 patients in GI and 54 in GII. The primary causes of renal failure were diabetes mellitus, hypertension, chronic glomerulonephritis, and polycystic kidney disease (P>.5). None of the patients received antimicrobial prophylaxis at the time of peritoneal catheter placement. After 8 weeks of follow-up of intermittent PD, 14 infectious events (24.5%), 11 exit site infections (19.3%), and 3 tunnel infections (5.3%) were observed in GI, and 3 exit site infections (6%) were observed in GII (P<.05).

Conclusions

Treatment with superoxidized solution had good efficacy and safety in the prevention of PD-related infections.

The guide WindowTM Venous Needle Guide (VWNG) is a device designed for extravascular subcutaneous vascular access provide a repeatable and reliable using the method of access only (eye or «buttonhole») for the insertion of the needle with precision in patients on hemodialysis. Of chronic use and can be cannulate several times a week. It is a device that consists of a single component of titanium and is available in eight sizes. It lists the indications, contraindications, the instructions for the appropriate use of the device as the selection of the size of the device, the surgical implantation of the device and the ten times of the implementation.

We report the case of a 41-year-old Mexican woman with systemic small vessel vasculitis affecting the kidney with pauci-immune rapidly progressive glomerulonephritis and diffuse pulmonary hemorrhage. This life-threatening condition warrants immediate intensive treatment with combination therapy with methylprednisolone, cyclophosphamide, and plasma exchange. The patient showed a transient improvement, with subsequent progressive deterioration. The results of renal biopsy showed high activity after treatment. B-cell lymphocyte depletion therapy (rituximab) was started, producing substantial clinical and histologic improvement, with complete remission.

Objective

To analyze the effectiveness and efficiency of monthly treatment with subcutaneous CERA (Mircera^®) in terms of maintaining previous levels of hemoglobin (Hb) and dose equivalence in patients on hemodialysis (HD) compared with previous treatment with weekly subcutaneous erythropoietin.

Methodology

We conducted a 6-month prospective study that included 30 HD patients with a stable dose of subcutaneous erythropoietin for the previous 3 months, replaced by an equivalent dose of monthly subcutaneous CERA administered according to the official data sheet. Hb, ferritin and the transferrin saturation index (TSI) were measured monthly and the dose of CERA was adjusted to maintain Hb between 11 and 13 g/dl.

Results

Of the 30 patients who began the study, 13 were withdrawn because of death, transplantation or a process that might interfere with the Hb level. Of the 17 patients who completed the 6-month study, 12 (70.6%) had stable Hb levels with minor variations of ± 1 g/dl. Mean levels of Hb, ferritin and TSI also remained stable and no differences were found between levels at baseline and 6 months later (Hb 11.6 ± 0.6 vs. 11.5 ± 0.9 g/dl). However, an increase in the average dose of CERA was required from 160.3 ± 40.6 at baseline to 200.0 ± 95.2 mg/month after 6 months (ns). The mean change in dose was an increment of 27.9 ± 5.9%. The average monthly cost per patient increased from 174.3 ± 85.4 € (erythropoietin) to 290.1 ± 69.0 € (baseline CERA) and finally to 361.6 ± 169.3 € (6-month CERA).

Conclusion

Replacement of subcutaneous erythropoietin by subcutaneous CERA maintained Hb within baseline levels but with an increased dose and cost. However, because of the small sample size, our results were not statistically significant.

The fluids used in the treatment of peritoneal dialysis (PD) as renal replacement therapy are inevitably bioincompatible due to their composition. These fluids may harm the peritoneal membrane, leading to inflammation, angiogenesis, vasodilatation, loss of mesothelial cells, epithelial-to-mesenchymal transition of these cells, fibrosis, encapsulating peritoneal sclerosis and membrane failure. Both experimental studies and clinical trials have investigated distinct mechanisms to reduce these effects, whether through the search for new biocompatible fluids or through the use of distinct drugs, administered intra- or extraperitoneally. In this article, we analyze the distinct studies performed in these 3 areas. The contribution of these types of study is essential to understand and improve the preservation of the peritoneum in order to optimize the technique of PD.

In young adults vertebral artery dissection (VAD) is an important cause of brain infarction. Diabetes insipidus following a spontaneous bilateral vertebral artery dissection is uncommon. We report a case of 50-year-old female presented with subarachnoid hemorrhage (SAH) after rupture of an extradural vertebral artery dissecting aneurysm. She went on to develop central diabetes insipidus and was treated in a conservative way.