ABSTRACT
Background: Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a condition of dialysis patients associated with both morbidity and mortality. Management is based on clinical guidelines with goals that are hard to comply with. Aim: To describe and compare biochemical variables associated with this disorder in two different time periods. Material and Methods: Revision of medical records of 814 patients (49% females) dialyzed during 2009 and 1018 patients (48% females), dialyzed during 2012 in Southern Metropolitan Santiago. Information about serum calcium, phosphorus, parathyroid hormone (PTH) and albumin was retrieved. Results: Median PTH values in 2009 and 2012 were 222.5 and 353.5 pg/ml respectively (p < 0.05). The figures for serum calcium corrected by albumin were 9.0 and 8.5 mg/dl respectively (p < 0.05). The figures for phosphorus were 4.7 and 5.0 mg/dl respectively (p < 0.05). The Calcium x Phosphorus product was 41.4 and 42.5 mg²/dl² (p < 0.05). Of note, the proportion patients with serum calcium below recommended levels (< 8.4 mg/dl) increased from 16% to 40% from 2009 to 2012. The proportion of patients with biochemical variables within recommended ranges was lower in 2012 than in 2009. Conclusions: There was a low proportion of patients with bone metabolism parameters within ranges recommended by clinical guidelines. These parameters were worst in 2012.
Subject(s)
Animals , Female , Male , Mice , Pregnancy , Adiposity/physiology , Animals, Suckling/metabolism , Cardiovascular Diseases/metabolism , Maternal Deprivation , Metabolic Syndrome/metabolism , Age Factors , Animals, Suckling/psychology , Blood Pressure/physiology , Body Weight/physiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/psychology , Glucose Intolerance/etiology , Glucose Intolerance/metabolism , Glucose Intolerance/psychology , Metabolic Syndrome/etiology , Metabolic Syndrome/physiopathology , Obesity/etiology , Obesity/metabolism , Obesity/psychology , PhenotypeABSTRACT
El pie diabético es la principal causa de amputación y mortalidad en pacientes diabéticos. Objetivo: establecer la frecuencia de amputaciones y característica clínicas en pacientes con el diagnóstico de pie diabético hospitalizados en el Hospital Clínico de la Universidad de Chile entre 1985-2000. Evaluar posibles factores de riesgo y la mortalidad posterior al egreso. Pacientes y método: análisis de ficha clínica, obtención de la fecha y causa de muerte del Servicio de Registro Civil e Identificación. Resultados: De 278 pacientes a 193 (69.4 por ciento) se les realizó una amputación. El nivel anatómico se distribuyó de la siguiente manera: 46 por ciento ortejo, 20 por ciento transmetatarsiana, 17 por ciento infracondílea y 17 por ciento supracondílea. Resultaron factores de riesgo para amputación: antecedente de amputación anterior (odds ratio [OR] 1.95, 95 por ciento IC 1.1-3.4); linfopenia ([OR] 0.96, 0.93-0.98); VHS aumentada ([OR] 1.012, 1.0044-1.02) y la presencia de retinopatía ([OR] 4.4, 2.2-9.1). La hospitalización fue más prolongada en los amputados (25 +/-22 vs 15 +/-13 días). El porcentaje de amputaciones en los períodos 1985 - 1994 y 1995 - 2000 fue similar (67 por ciento vs 70 por ciento). Un 35 por ciento de los pacientes amputados y un 52 por ciento de los no amputados fallecieron en un promedio de 3.38 años (rango 0-15.5 y 0-11.8 respectivamente). La primera causa de muerte en el grupo no amputado fue la cardiovascular y en el grupo amputado, fue la causa séptica. Conclusiones: aún existe una elevada frecuencia de amputaciones por pie diabético en nuestro medio lo que se asocia a hospitalizaciones prolongadas. El pie diabético complicado determina una elevada mortalidad antes de los 5 años del egreso.
The diabetic foot is the main cause of amputation and mortality in diabetic patients. Aim: To determine the frequency of lower extremity amputations and clinical features in patients with the diagnosis of diabetic foot assisted at the University of Chile Clinical Hospital between 1985-2000 to determine risks factors and mortality after the discharge. Patients and Method: Analysis of patient records and obtainment of the date and cause of death from the National Register of Citizens. Results: Of 278 patients 193 patients (69.4 percent) underwent an amputation. The anatomic level was: 46 percent toe; 20 percent transmetatharsal; 17 percent under the knee and 17 percent over the knee. Risk factors for amputation were: history of amputation (odds ratio [OR] 1.95, 95 percent IC 1.1-3.4); low lymphocytes count ([OR] 0.96, 0.93-0.98); high eritro sedimentation rate ([OR] 1.012, 1.0044-1.02) and retinopathy ([OR] 4.4, 2.2-9.1). Longer hospitalizations were observed in amputee patients (25 +/- 22 vs 15 +/- 13 days). A similar frequency of amputations was observed between 1985-1994 and 1995-2000 periods. A 35 percent of amputee patients and 52 percent of non amputee patients died in a mean of 3.34 years after the event (range 0-15.5 y 0-11.8 respectively). Among non amputee patients the main cause of death was cardiovascular disease and infectious processes were the main cause in amputee patients. Conclusions: A high frequency of amputations because diabetic foot is still observed in our diabetic patients that is associated to longer hospitalizations. The complicated diabetic foot determines a high mortality before 5 years of the event.