Diálisis y Trasplante最新文献

Introduction

Maximizing the control of conventional risk factors should be crucial in patients with chronic kidney disease due to their high cardiovascular risk. Recent studies suggest that lipid control using the combination of a statin and ezetimibe may have benefits in this specific population.

Material and methods

From September-2011 to September-2014, 22 patients with chronic kidney disease, stage 3-4 who did not reach optimal lipid levels in monotherapy with statin were included in the study. Mean age 67 ± 8 years. Half of the patients were smokers, 68% were diabetic and all of them received hypertensive treatment.

Results

Baseline, 6 months and one year follow-up controls were performed. Total cholesterol mean baseline and at one year was 202 ± 39 mg/dl and 147 ± 38 (P=.001), LDL, HDL and triglycerides baseline and at one year were as follows respectively: 123 ± 27 vs. 73 ± 28 (P=.0005), 45 ± 12 vs. 49 ± 11 (P=n. s.) and 195 ± 104 vs. 131 ± 57 mg/dl (P=n.s.). The estimated glomerular filtration rate basal medium was 37 ± 14 ml/min and one year: 37 ± 13 ml/min (P=n.s.) and urinary albumine/creatinine ratio, UA/Cr. was basal and one year: 679 vs. 523 mg/g (P=n.s.).

Conclusions

The combination of simvastatin plus ezetimibe in CKD patients appears to be effective in lipid control at least in this follow-up period. No serious side effects associated have been observed. Demonstrating a reduction in cardiovascular risk associated with greater control of lipid levels requires a longer period of monitoring.

Introduction

Hyperglycemia has been considered as a negative factor in hospitalized patients, both diabetic and non-diabetic, and has been related to the presence of diverse adverse outcomes. In kidney transplant patients, surgical stress, immunosuppressive drugs and prolonged hospital stays may be factors that promote hyperglycemia. However, has not been studied whether hyperglycemia during transplantation is associated with increased risk of rejection.

Population and methods

A retrospective cohort study in patients older than 15 years who received a kidney transplant and that included measurements of glucose in the first 48 hours after transplantation. We evaluated the presence of hyperglycemia defined in three different ways (as a single value, as averaged value and as time-weighted value) in patients undergoing renal transplantation and its relationship to the risk of acute rejection and length of hospital stay.

Results

While a large number of patients (91%) had some form of hyperglycemia during the first 48 hours after transplantation regardless of how it was defined, there was no an increased risk of rejection (OR = 0.35; 95% CI = 0.11-1.08) or a difference in length of stay (13.2 vs. 8.9 days, P = .958).

Conclusions

It is common to find some form of hyperglycemia during the first 48 hours after kidney transplantation, but its presence does not entail increased risk of transplant rejection or longer hospital stay when compared with patients who did not present it.

Introduction

An institutional register of patients with developing dialysis is currently available.

General objective

The aim was to identify epidemiological aspects of chronic renal failure (CRF) in the Mexican Institute of Social Security.

Material and methods

This was a retrospective cohort that included the data obtained from the 35 delegations that constitute the second level of medical attention for the month of December 2013.

Results

There were 56,430 patients, 0.1% of the user population; 32,190 male (57%) and 24,240 females (43%), with an average age of 62 years (range, 18-90). The primary causes of CRF were diabetes, 29,661 (52.6%); high blood pressure, 19,862 (35.2%); and chronic glomerulopathy, 4,089 (7.2%). Of the total, 33,754 (60%) patients received peritoneal dialysis (PD) and 22,676 (40%), haemodialysis (HD). The highest prevalence was seen in Jalisco, the state of México Oriente and the southern Federal District, while the lowest was found in Campeche, southern Baja California and Zacatecas. General incidence was 124 cases per thousand users; the delegations with the highest incidence were Tlaxcala, Morelos and Hidalgo, while those of the lowest were Zacatecas, Sinaloa and the northern Federal District. The most frequent PD complications were peritonitis, fluid overload and mechanical catheter complications; the most frequent in HD were fluid retention, lack of hypertension control and hyperkalemia. Definitive exit in the 2 modes of dialysis were myocardial infarction, sepsis, heart failure and acid-base balance disorders.

Conclusions

These results constitute a referential framework and can provide the guidelines to initiate specific pathways of prevention, treatment and research. These will, in turn, make it possible to improve the quality of life of the patient undergoing dialysis and to optimise institutional resources.

Background

Methicillin-resistance Staphylococcus aureus (MRSA) nasal carriage plays a key role in the pathogenesis of MRSA infections in hemodialysis patients. Our study was designed to evaluate the prevalence of MRSA nasal carriage in patients on chronic hemodialysis and its influence on development of MRSA bloodstream infections.

Methodology

Ours is a 12-month prospective observational study. A total of 50 patients who are on chronic maintenance hemodialysis were enrolled in this study. Prevalence of MRSA nasal carriage was studied using nasal swabs collected from the anterior nares. Swabs were inoculated on to Mannitol Salt Agar and HiCrom agar. Bactec blood culture was used to detect MRSA bloodstream infections.

Results

Staphylococcus aureus (S. aureus) nasal carrier state was detected 62% of patients. 83.87% of these S. aureus nasal carriers were found to be having MRSA. The incidence of MRSA bloodstream infections was 1.54 episode per 100 patient-months. MRSA bloodstream infection rates were significantly higher among MRSA nasal carriers as compared to non-MRSA carriers (p < 0.001). Low hemoglobin levels were significantly more among MRSA positive nasal carriers as compared to non-MRSA nasal carriers.

Conclusion

This study reveals that MRSA nasal carriage is more prevalent among hemodialysis patients and it is an independent risk factor for the development of MRSA bloodstream infections. Early prevention and treatment of MRSA nasal carriage in hemodialysis patients may prevent MRSA bloodstream infections in hemodialysis patients.

Information is a key factor to improve the physical and psychological situation of the patient. In the Lozano Blesa Dialysis Unit, in Zaragoza, the level of knowledge of the patients was evaluated before joining the haemodialysis (HD) programme. The strengths and weaknesses of the Unit were identified, and a plan of action was determined to rectify the deficiencies detected.

A total of 36 of the 69 patients were selected. A descriptive, cross-sectional study, using qualitative questionnaire. Questions were related to the quality of the information, concepts of HD, diet, home treatment and medication, vascular access and its maintenance, different dialysis techniques, and the dialysis centre. The results obtained were the basis for writing a guidance manual for the patient, to justify other interventions, and to promote the chronic kidney diseas (CKD) pre-dialysis clinic.

Introduction

Dialysis presents a financial challenge for health institutions. The overall objective of this study was to identify the cost of investment in re-admissions to peritoneal dialysis (PD) after prior hemodialysis (HD).

Material and methods

Cross-sectional, open study conducted from January to October 2013. Demographic variables included: initial and subsequent dialysis, cause of admission to HD, time on HD, cost of the return to PD process (lab tests, meetings, inter-departmental consultations, surgical time, intermittent PD, bed days, and total cost); substitution and internal HD sessions that could be added to the estimated economic investment.

Results

A total of 10 patients, 6 male and 4 female, mean age 49.4 years (range: 26-75), all with type 2 diabetes mellitus, were included. The tests performed included; 6 abdominal ultrasounds, 11 X-rays (mean: 1.1; range: 0-2), 11 electrocardiograms (mean: 1.1; range: 0-2), and 135 laboratory tests, with a mean of 13.5 per patient (range: 7-26). One abdominal CT scan was performed. Peritoneal catheters were inserted surgically. There were 89 sessions of Intermittent peritoneal dialysis (mean: 8.9; range: 0-14) using 210 bed days (mean: 21; range: 13-27). The resolution of the cases was one entry to substitution HD program, 1 death, 1 dropout, 2 continuous ambulatory, 4 automated, and 1 intermittent peritoneal dialysis. The total cost of comprehensive care was 1,381,810.79 Mexican pesos, average per patient of 138,181.07 (range: 101,094.38 to 197,710.38).

Conclusions

The return of hemodialysis substitution patients to peritoneal dialysis did not prove to be cost effective for the hospital.