ABSTRACT
Aiming to know the factors that influenced the use of erythropoietin (EPO) in chronic hemodialysis patients, we retrospectively studied 82 patients (41 male), of whom 15 received EPO. No differences, between patients receiving or not receiving EPO, were found in age (46.9ñ25 and 57ñ13 years respectively), male/female ratio (9/6 and 32/35 respectively), time on dialysis (36.4ñ25.6 and 36.8ñ31.8 months respectively), dialysis hours (3.19ñ0.6 and 3.33ñ0.39 h respectively) and proportion of diabetics (6.6 and 20.8 percent respectively). Prior to EPO use and compared to untreated patients, treated patients were transfused with a higher frequency (60 vs 22 percent) and with more units/patients/years (0.12 vs 0.08). Hemoglobin levels at the start of the treatment was similar in treated and untreated patients (8.4ñ1.46 vs 8.78ñ1.97 g/dl). Epo was indicated in 11 patients due to general symptomatology associated to anemia and in 4 due to cardiac failure or angina. We conclude that EPO treatment is indicated in approximately 18 percent of patients in dialysis. An adequate dialytic treatment may achieve optimal hemoglobin levels with minimal transfusion requirements and without need of EPO, thus reducing costs
Subject(s)
Humans , Male , Female , Erythropoietin/administration & dosage , Anemia/drug therapy , Renal Insufficiency, Chronic/drug therapy , Iron/administration & dosage , Folic Acid/administration & dosage , Renal Dialysis/adverse effects , Blood TransfusionABSTRACT
Since 1981, we have treated 46 adults aged 56 ñ 21 years, of whom 17 were diabetic, with intermittent peritoneal dialysis. Their main time on dialysis has been 21 months with an accumulated experience of 493 months/patient. The program included 2 dialyses per week, 25 exchanges of 21 session and 30 min of dwell time. Arterial pressure control has been satisfactory. Diabetic patients had a lower levels of serum calcium, alkaline phosphatases and m-PTH. The incidence of peritonitis has been 1 episode/14 months/patient and the causative agent has been Staphylococcus aureus in 47 percent of episodes. Mean catheter duration has been 15 months and 1 episode/34 months/patient of exit site infection has been recorded and Staphylococcus aureus has beeb the causative agent in 83 percent episodes. The risk of acquiring the first peritonitis was 12 percent at 3 months, 23 percent at 6 months and higher for non diabetic patients. Actuarial survival of treated patients at 12 and 24 months was 89 and 67 percent respectively. No differences in survival were recorded between diabetic and non diabetic patients. Fifty two percent of patients that dropped out continued on hemidialysis, 23 percent, 11 percent abandoned treatment, 8 percent continued on chronic ambulatory peritonela dialysis and 60 percent received a kidney allograft. We conclude that intermittent peritoneal dialysis is a good alternative treatment of chronic renal failure, even in diabetic patients
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Peritoneal Dialysis, Continuous Ambulatory/methods , Renal Insufficiency, Chronic/therapy , Peritonitis/diagnosis , Staphylococcus aureus/isolation & purification , Catheterization/adverse effects , Nutritional Status , Diabetes Mellitus/complications , Staphylococcal Infections/complications , Dialysis Solutions/pharmacologyABSTRACT
Se estudiaron prospectivamente 2 poblaciones de pacientes en diálisis crónica controlados con dos modalidades diferentes de programas de exámenes. La mayor parte del tiempo el agua de diálisis fue tratada con deionizador/osmosis reversa. El grupo A con 44 pacientes, edad promedio de 58 +/- 15.4 años, tiempo en dialisis de x 31.9 +/-22.5 meses fue controlada con un programa restringido el que incluía medición mensual de hemoglobina, trimestral de calcemia, fosfemia, calemia y fosfatasas alcalinas; anual de paratohormona y radiografía de manos y de marcadores virales cada 6 meses. El grupo B con 31 pacientes, edad promedio 56.9 +/- 13.8 años, tiempo en díalisis de promedio 33.8 +/- 30.5 meses fue controlado con un programa amplio y frecuente de exámenes. El porcentaje de diabéticos fue similar en ambos grupos. No hubo diferencia significativa en la mortalidad (18.1 por ciento para el A y 29 por ciento para el B, NS) hospitalizaciones (064/pacientes/año para el A y 1.5 para el B, NS), transfusiones (1.1 transfusiones/pacientes/año para el A y 1.5 para el B, NS) y administración de eritropoietina (9 por ciento de los pacientes del grupo A y 9.6 por ciento del B, NS). Un paciente de cada grupo desarrolla síndrome urémico por causas evidentes y específicas. En el grupo B se comprobó una mayor incidencia de hipercalemia asintomática como consecuencia de la medición mensual de este parámetro. Concluímos que disponiendo de un adecuado tratamiento del agua de díalisis y conociendo los marcadores virales de los pacientes a su ingreso es posible el control adecuado del tratamiento mediante un programa muy reducido de exámenes lo que disminuye costos y racionaliza su solicitud. Al esquema propuesto debe agregarse la medición frecuente de la potasemia por su valor en el diagnóstico de hipercalemia asintomática
Subject(s)
Humans , Male , Female , Middle Aged , Renal Dialysis/methods , Renal Insufficiency, Chronic/therapy , Renal Dialysis/standards , Nutrition for Vulnerable GroupsSubject(s)
Aged , Humans , Male , Female , Renal Dialysis , Follow-Up Studies , Diabetes Mellitus , PrognosisABSTRACT
Chronic dyalisis was discontinued in 11 patients with end stage renal disease. Most patients were diabetics of old age and all had presented a variety of acute medical complications. The patient initiated the decision in 2 cases, the medical team in 4 and the medical team and family in 5. Five patients were mentally incompetent when the decision was made