Nutritional status and body composition after 6 months of patients switching from continuous ambulatorial peritoneal dialysis to automated peritoneal dialysis

Our objective was to determine if automated peritoneal dialysis (APD) leads to changes in nutritional parameters of patients treated by continuous ambulatory peritoneal dialysis (CAPD). Twenty-six patients (15 males; 50.5 ± 14.3 years) were evaluated during CAPD while training for APD and after 3 and 6 months of APD. Body fat was assessed by the sum of skinfold thickness and the other body compartments were assessed by bioelectrical impedance. During the 6-month follow-up, 12 patients gained more than 1 kg (GW group), 8 patients lost more than 1 kg (LW group), and 6 patients maintained body weight (MW group). Except for length on dialysis that was longer for the LW group compared with the GW group, no other differences were found between the groups at baseline. After 6 months on APD, the LW group had a reduction in body fat (24.5 ± 7.7 vs 22.1 ± 7.3 kg; P = 0.01), body cell mass (22.6 ± 6.2 vs 21.6 ± 5.8 kg, P = 0.02) and phase angle (5.4 ± 0.9 vs 5.1 ± 0.8 degrees, P = 0.004). In the GW group, body fat (25 ± 7.6 vs 27.2 ± 7.6 kg, P = 0.001) and body cell mass (20.1 ± 3.9 vs 20.8 ± 4.0 kg, P = 0.05) were increased. In the present study, different patterns of change in body composition were found. The length of previous dialysis treatment seems to be the most important factor in determining these nutritional modifications.

Nutritional status of hemodialysis patients with secondary hyperparathyroidism

The repercussions of secondary hyperparathyroidism on the nutritional status of chronic renal failure patients have not been well established. Therefore, the aim of this study was to compare the nutritional indices of hemodialysis patients with and without secondary hyperparathyroidism. Sixteen hemodialysis patients with serum parathyroid hormone (PTH) levels higher than 420 pg/ml (hyperparathyroidism group) were matched for gender, age and length of dialysis treatment to 16 patients with serum PTH between 64 and 290 pg/ml (control group). The following parameters were assessed: anthropometric indices (body mass index, skinfold thickness, midarm muscle circumference and body fat), 4-day food diaries, protein catabolic rate, biochemical indices (blood urea nitrogen, serum creatinine, albumin, ionized calcium, inorganic phosphorus, serum alkaline phosphatase, PTH, pH and HCO3) and dialysis efficiency. We did not observe differences in the anthropometric indices between the two groups. Only calcium intake was significantly different between groups (307.9 mg/day for the hyperparathyroidism group vs 475.8 mg/day for the control group). Protein catabolic rate tended to be higher in the hyperparathyroidism group compared to the control group (1.3 vs 0.9 g kg-1 day-1; P = 0.08). Except for blood urea nitrogen (86.4 vs 75.7 mg/dl), alkaline phosphatase (175 vs 65 U/l) and PTH (898 vs 155 pg/ml), no other differences were found between groups in the biochemical indices studied. PTH was directly correlated with protein catabolic rate (r = 0.61; P<0.05) and length of dialysis (r = 0.53; P<0.05) only in the hyperparathyroidism group. Considering the indices used, we could not demonstrate the deleterious effect of high PTH levels on the nutritional status of hemodialysis patients. Indirect evidence, however, suggests an action of PTH on protein metabolism

Glomerular hemodynamics during abortion induced by RU 486 and sepsis in rats

1. Acute renal failure is a very common consequence of septic abortion. Whole kidney and glomerular hemodynamics were evaluated in virgin (V), pregnant (PREG) and aborted (ABOR) euvolemic Munich-Wistar rats before and after E. coli (0111-B4) endotoxin (LPS) infusion in order to evaluate the effect of septic abortion on the renal microcirculation. 2. Abortion induced by RU 486 blunted the increase in glomerular filtration rate (GFR) induced by normal pregnancy (0.86 +/- 0.03 vs 0.63 +/- 0.07 ml/min, P < 0.05). In virgin rats, RU 486 did not modify the parameters of renal function. Significant alterations occurred in whole kidney and single nephron function. However, the changes in whole kidney function in the ABOR group were significantly higher than those observed for the V group (reductions in GFR were 42 in V and 80 in ABOR, RPF decreased 34 in V and 76 in ABOR, TRVR increased 82 in V and 400 in ABOR). 3. Mean single nephron glomerular filtration rate (SNGFR) was reduced in all groups after LPS (44 in V, 43 in V+RU, 55 in PREG, 60 in ABOR), due to significant decreases in glomerular plasma flow rate, QA (42 in V, 55 in V+RU, 53 in PREG, 57 in ABOR) and in glomerular ultrafiltration coefficient, Kf (46 in V, 47 in V+RU, 45 in PREG, 67 in ABOR). 4. These data show that LPS induced significant alterations in renal function in all groups. However, aborted rats were more sensitive to the effects of LPS than V rats. These results indicate that abortion may potentiate the effects of endotoxemia on renal function elevating the extent of acute renal failure and thus the mortality rate.

Correçäo da anemia da insuficiência renal crônica pela eritropoetina humana recombinante liofilizada por via subcutânea / Anemia correction of chronic kidney failures by recombinant human erythropoietin freeze drying by subcutaneous injections

A eritropoetina recombinante humana (rHuEPO) tem-se mostrado a medicaçäo de escolha na correçäo da anemiado paciente renal crônico. OBJETIVO. Analisar a eficácia de uma nova preparaçäo de rHuEPO na correçäo da anemia de pacientes renais crônicos mantidos em hemodiálise, exclusivamente administrada por via subcutânea, estudando seus efeitos colaterais e pesquisando fatores preditivos de resposta para a medicaçäo. MÉTODOS. Doze pacientes em programa regular de hemodiálise foram tratados com rHuEPO liofilizada por via subcutânea, durante 18 meses, com dose inicial de 20U/Kg/diálise, efetuando-se monitorizaçäo clínica e laboratorial adequada. RESULTADOS. Onze pacientes terminaram o protocolo, alcançando hematócrito (Htc) alvo de 30 por cento e mantendo-o durante todo o tempo de estudo. A dose média utilizada para a correçäo da anemia foi de 65U/Kg diálise e a de manutençäo de Htc alvo de 51U/Kg diálise. Já na 12ª semana do estudo, comprovou-se aumento significativo do Htc (18,4 ñ 3,5 por cento vs. 25,4 ñ 3,8 por cento, p < 0,5), acompanhado por hemoglobina e eritrócitos. Leucócitos e plaquetas aumentaram significativamente a partir da 24ª semana e mantiveram-se assim até o final do estudo. Na análise dos exames bioquímicos dos pacientes, apenas o potássio se elevou na 4ª e 12ª semanas, voltando ao basal na 24ª semana de estudo. A avoluçäo dos parâmetros séricos do metabolismo do ferro mostrou diminuiçöes intermitentes e estatisticamente significantes da saturaçäo de transferrina na 1ª, 12ª e 24ª semanas, voltando aos valores basais ao final do estudo; a ferritina sérica näo se alterou (582,7 ñ 700,9ng/mL vs. 700,0 ñ 651,6ng/mL). Peso e pressäo arterial näo se alteraram, porém dois pacientes, antes normotensos, tornaram-se hipertensos e dois outros, com hipertensäo controlada, necessitaram reajuste de droga para novo controle da pressäo (35 por cento). Um paciente apresentou convulsäo tipo grande mal, evoluindo sem seqüelas. CONCLUSAO. A rHuEPO utilizada neste protocolo comprovou ser uma droga eficaz, segura e com efeitos colaterais passíveis de controle

Dietary habits of calcium stone formers

1. Since dietary factors are known to be related to nephrolithiasis, calcium stone-forming (CSF) patients were evaluated in terms of calcium, total protein of both animal and plant origin, carbohydrate and energy intakes, on the basis of 72-h dietary records during the week plus 24-h dietary records during the week-end. 2. The data for 77 calcium stone formers (57 with absorptive hypercalciuria and 20 with renal hypercalciuria) were compared to those for 29 age-matched healthy subjects. The body mass index of the CSF group was higher than that of healthy subjects (P < 0.05). Consumption of all nutrients was similar for both groups during the week but week-end dietary records for CSF showed higher calcium intake (586 +/- 38 vs 438 +/- 82 mg/day, P < 0.05), protein to body weight ratio (1.2 +/- 0.1 vs 1.0 +/- 0.5 g kg-1 day-1, P < 0.05) and animal protein (56 +/- 3 vs 40 +/- 3 g/day, P < 0.05) when compared with healthy subjects. 3. Comparison of hypercalciuria subtypes (renal hypercalciuria and absorptive hypercalciuria) did not indicate any difference in calcium or energy intake between groups, either during the week or during the week-end. However, the absorptive hypercalciuric group presented higher protein and animal protein consumption during the week-end. 4. These data suggest a low calcium intake in this population, even by stone formers. The higher animal protein consumption by our calcium stone formers observed during week-ends seems to be more important than calcium intake for stone formation

Radioimmunoassay of carboxyl and amino terminal fragments of parathyroid hormone for the evaluation of secondary hyperparathyroidism in chronic renal failure

1. Some parameters of calcium and phosphorus metabolism and the radioimmunoassay of plasma concentrations of both the carboxyl (COOH) (residues 53-84) and amino (NH2) terminal (residues 1-34) fragments of parathyroid hormone (PTH) were measured to evaluate secondary hyperparathyroidism in 68 patients with chronic renal falure (CRF), 34 of whon were on hemodialysis therapy. 2. The upper limits of the normal values for serum PTH-NH2 and PTH-COOH concentrations were 28 and 146 pmol/l, respectively. Patients with mild CRF (plasma creatinine (CRp) 1.2-2 mg/dl) hadh normal mean serum total calcium, low mean phosphorus, undetectable plasma levels of PTH-COOH concentration and normal fractional excretion of phosphorus (FEP). Patients with moderate CRF (CRp2.1-4 mg/dl) had normal mean serum concentrations of both total calcium and phosphorus, and elevated mean levels of both plasma PTH-COOH and PTH-NH2 associated with increased FEP. Patients with end-stage CRF (CRp > 4mg/dl) and those on hemodialysis had elevated mean serum phosphorus levels and decreased mean serum total calcium concentrations compared with those with mild and modetate CRF, and more pronounced, increases in both mean plasma PTH-COOH and PTH-NH2. 3. The logarithm of plasma PTH-NH2, but not PTH-COOH, concentration correlated positively with FEP and serum phosphorus concentration and negatively with total serum calcium concentration, while the logarithms of both PTH-NH2 and PTH-COOH levels correlated positively with CRp. 4. Calcium infusion (2 mg Kg-1 h-1 for 90 min) in eight patients with high plasma levels of PTH-NH2, and PTH-COOH resulted in a significant decrease of plasma PTH-NHL but not of plasma PTH-COOH concentration. 5. These data demonstrate increased plasma PTH levels in moderate renal failure and suggest that the assay of plasma PTH-NH2 rather than PTH-COLL is more appropriate for the evaluation of secondary hyperparathyroidism in chronic renal failure