Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 1.110
Filter
1.
Arch. argent. pediatr ; 118(2): e178-e182, abr. 2020. tab, ilus
Article in Spanish | LILACS (Americas), BINACIS | ID: biblio-1100431

ABSTRACT

La enfermedad de jarabe de arce es una entidad autosómica recesiva producida por un error congénito en el metabolismo de tres aminoácidos esenciales de cadena ramificada: valina, leucina e isoleucina. La forma neonatal de esta enfermedad se manifiesta por un cuadro de compromiso neurológico grave y progresivo, asociado a un olor peculiar de la orina, consecuencia de la eliminación del exceso de estos aminoácidos. Este olor a azúcar quemada remeda a la melaza obtenida de los arces, lo que da nombre a esta enfermedad. El mejor método para eliminar estos tóxicos es la hemodiafiltración, pero, en los centros en los que esta práctica no es posible, la diálisis peritoneal constituye una alternativa.Se presenta a un recién nacido con leucinosis, con compromiso grave del sistema nervioso central, en quien la diálisis peritoneal fue de utilidad para superar la descompensación metabólica.


Maple syrup disease is an autosomal recessive entity caused by a congenital error in the metabolism of three essential branched-chain amino acids: valine, leucine and isoleucine. The neonatal form of this disease is expressed by a severe and progressive neurological compromise, associated with a peculiar smell of urine, a consequence of the elimination of the excess of these amino acids. This smell of burnt sugar mimics the molasses obtained from maples, which gives its name to this disease. The best method to eliminate these toxins is hemodiafiltration, but in centers where this practice is not possible, peritoneal dialysis is an alternative.We present a newborn with leukinosis with severe central nervous system involvement in whom peritoneal dialysis was useful to overcome metabolic decompensation.


Subject(s)
Humans , Male , Infant, Newborn , Peritoneal Dialysis , Maple Syrup Urine Disease/diagnosis , Urine/chemistry , Weight Loss , Maple Syrup Urine Disease/therapy
2.
Saude e pesqui. (Impr.) ; 13(1): 63-72, jan/mar 2020. ilus, tab
Article in Portuguese | LILACS (Americas) | ID: biblio-1052900

ABSTRACT

O objetivo deste estudo foi avaliar o consumo alimentar e fatores associados de pacientes com Doença Renal Crônica em terapia renal substitutiva do tipo diálise peritoneal. Trata-se de um estudo transversal que avaliou dados sociodemográficos, hábitos de vida, estado nutricional e condição clínica com o consumo alimentar destes pacientes. Dos indivíduos avaliados, 73,5% (n=25) apresentaram consumo fora do recomendado de calorias e carboidratos, 76,5% (n=32) de proteína e 52,95% (n=18) de lipídios. Encontraram-se altas prevalências de inadequação para o consumo de cálcio, ferro, zinco e fósforo. Foi associado à maior inadequação no consumo de carboidratos o fato do paciente ser aposentado/afastado (p=0,025) e ser desnutrido/eutrófico (p=0,003). O consumo lipídico inadequado foi mais presente nos homens (61,01%, p=0,045) e o consumo adequado associou-se aos aposentados/afastados (p=0,026) e aos eutróficos (p=0,023). Foi identificado consumo abaixo do recomendado de calorias, carboidrato e proteína e acima do recomendado para lipídios.


Food intake by chronic kidney patients and associated factors in substitute kidney therapy, such as peritoneal dialysis, are evaluated by a transversal study that evaluated sociodemographic data, life style, nutritional status and clinical conditions with the patients´ food intake. Twenty-five (73.5%) patients consumed food with less calories and carbohydrates; 76.5% (n=32) with less protein and 52.95% (n=18) with excess lipid. There were also high amounts of calcium, iron, zinc and phosphorus. The fact that the patient was retired (p=0.025) and undernourished/eutrophic (p=0.003) was a compounding factor to carbohydrate intake. Inadequate lipids intake was more pronounced in males (61.01%, p=0.045) and inadequate intake was associated with retirement (p=0.026) and eutrophic conditions (p=0.023). Results show low intake of calories, carbohydrates and protein and excess in lipids.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Socioeconomic Factors , Food Consumption , Peritoneal Dialysis , Renal Insufficiency, Chronic
3.
Yonsei Medical Journal ; : 56-63, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-782123

ABSTRACT

PURPOSE: Elevated aryl hydrocarbon receptor (AhR) transactivating (AHRT) activity and uremia in chronic kidney disease (CKD) may interact with each other, further complicating the disease course. In this study, we prospectively estimated serum AHRT activity using a highly sensitive cell-based AhR-dependent luciferase activity assay in CKD patients and compared differences therein according to treatment modality.MATERIALS AND METHODS: Patients undergoing peritoneal dialysis (PD) (n=22) and hemodialysis (HD) (n=38) and patients with pre-dialysis CKD stage IV or V (n=28) were included. AHRT activity and intracellular adenosine triphosphate (ATP) levels were measured. We performed a correlation analysis for AHRT activity, ATP levels, and various clinical parameters.RESULTS: AHRT activity and intracellular ATP levels were inversely correlated and differed according to treatment modalities. AHRT activity was higher in non-dialysis CKD patients than in patients undergoing dialysis and was higher in patients undergoing HD, compared to PD. AHRT activity decreased after HD treatment in HD patients. ATP levels were higher in healthy controls than in patients with pre-dialysis CKD and PD and were further decreased in patients with HD. We noted significant correlations between multiple clinical parameters associated with cardiovascular risk factors and AHRT activity.CONCLUSION: AHRT activity was elevated in CKD patients, while dialysis treatment reduced AHRT activity. Further studies are warranted to specify AHRT activity and to evaluate the precise roles thereof in patients with CKD.


Subject(s)
Adenosine Triphosphate , Dialysis , Humans , Luciferases , Peritoneal Dialysis , Prospective Studies , Receptors, Aryl Hydrocarbon , Renal Dialysis , Renal Insufficiency, Chronic , Risk Factors , Uremia
4.
Article in English | WPRIM (Western Pacific) | ID: wprim-762455

ABSTRACT

BACKGROUND: Anti-carbohydrate antibody responses, including those of anti-blood group ABO antibodies, are yet to be thoroughly studied in humans. Because anti-ABO antibody-mediated rejection is a key hurdle in ABO-incompatible transplantation, it is important to understand the cellular mechanism of anti-ABO responses. We aimed to identify the main human B cell subsets that produce anti-ABO antibodies by analyzing the correlation between B cell subsets and anti-ABO antibody titers. METHODS: Blood group A-binding B cells were analyzed in peritoneal fluid and peripheral blood samples from 43 patients undergoing peritoneal dialysis and 18 healthy volunteers with blood group B or O. The correlation between each blood group A-specific B cell subset and anti-A antibody titer was then analyzed using Pearson's correlation analysis. RESULTS: Blood group A-binding B cells were enriched in CD27⁺CD43⁺CD1c− B1, CD5⁺ B1, CD11b⁺ B1, and CD27⁺CD43⁺CD1c+ marginal zone-B1 cells in peripheral blood. Blood group A-specific B1 cells (P=0.029 and R=0.356 for IgM; P=0.049 and R=0.325 for IgG) and marginal zone-B1 cells (P=0.011 and R=0.410 for IgM) were positively correlated with anti-A antibody titer. Further analysis of peritoneal B cells confirmed B1 cell enrichment in the peritoneal cavity but showed no difference in blood group A-specific B1 cell enrichment between the peritoneal cavity and peripheral blood. CONCLUSIONS: Human B1 cells are the key blood group A-specific B cells that have a moderate correlation with anti-A antibody titer and therefore constitute a potential therapeutic target for successful ABO-incompatible transplantation.


Subject(s)
Antibodies , Antibody Formation , Ascitic Fluid , B-Lymphocyte Subsets , B-Lymphocytes , Healthy Volunteers , Humans , Immunoglobulin M , Peritoneal Cavity , Peritoneal Dialysis
6.
J. bras. nefrol ; 41(4): 560-563, Out.-Dec. 2019.
Article in English | LILACS (Americas) | ID: biblio-1056609

ABSTRACT

ABSTRACT Human-induced climate change has been an increasing concern in recent years. Nephrology, especially in the dialysis setting, has significant negative environmental impact worldwide, as it uses large amounts of water and energy and generates thousands of tons of waste. While our activities make us responsible agents, there are also several opportunities to change the game, both individually and as a society. This call-to-action intends to raise awareness about environmentally sustainable practices in dialysis and encourages this important discussion in Brazil.


RESUMO A mudança climática induzida pela atividade humana tem sido foco de preocupações crescentes nos últimos anos. A nefrologia, particularmente a diálise, produz significativos impactos ambientais em todo o mundo em virtude da grande utilização de água e energia e da geração de milhares de toneladas de resíduos. Embora nossas atividades nos tornem agentes responsáveis, há várias oportunidades para mudar esse cenário, tanto individualmente como em sociedade. O presente artigo pretende ampliar a conscientização sobre práticas ambientalmente sustentáveis em diálise e estimular essa importante discussão no Brasil.


Subject(s)
Humans , Program Evaluation/methods , Renal Dialysis/methods , Peritoneal Dialysis/methods , Awareness/physiology , Climate Change/statistics & numerical data , Brazil/epidemiology , Waste Disposal, Fluid/statistics & numerical data , Health Personnel/ethics , Conservation of Natural Resources/methods , Environment
7.
Med. leg. Costa Rica ; 36(2): 108-114, sep.-dic. 2019. tab
Article in Spanish | LILACS (Americas) | ID: biblio-1040451

ABSTRACT

Resumen La diálisis peritoneal es uno de los métodos de reemplazo renal para pacientes con enfermedad renal crónica avanzada. Las infecciones representan la segunda causa de muerte y corresponden a gran morbilidad en este grupo de pacientes. La peritonitis asociada a diálisis peritoneal es una patología prevenible y es la principal complicación de este procedimiento. En la mayoría de ocasiones, la etiología es secundaria a bacterias Gram positivas colonizadoras de la piel, aunque no se puede subestimar la importancia de las bacterias Gram negativas. El diagnóstico se basa tanto en el criterio clínico como microbiológico. El tratamiento corresponde en antibióticos por un periodo de por lo menos dos semanas. Esta revisión de tema permite informar al personal de salud, pacientes y cuidadores sobre esta frecuente complicación con el fin de prevenirla, y en su defecto, un diagnóstico y tratamiento temprano con el fin de reducir la morbimortalidad y las complicaciones de dicho cuadro clínico.


Abstract Peritoneal dialysis is one of the main renal replacement therapies for end-stage renal disease. Infections represent the second leading cause of death and correspond to great morbidity in this group of patients. Peritonitis associated with peritoneal dialysis is a preventable disease, and it is also the main complication of this procedure. Most cases are secondary to Gram-positive bacteria skin colonizers; although the importance of Gram-negative bacteria cannot be underestimated. Diagnosis is based both on clinical and microbiological criteria. Treatment consists on at least a two-week period antibiotic scheme. This topic review allows health care providers, patients and caregivers to be informed about this usual complication in order to prevent it, diagnose it and initiate early treatment with the intention to minimize its morbidity, mortality and complications.


Subject(s)
Humans , Peritoneal Cavity , Peritonitis/complications , Peritoneal Dialysis , Renal Replacement Therapy , Renal Insufficiency, Chronic
8.
Rev. enferm. UERJ ; 27: e34084, jan.-dez. 2019. ilus, tab
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1009995

ABSTRACT

Objetivo: analisar a autopercepção de saúde e os fatores associados dos indivíduos com doença renal crônica em terapia dialítica. Método: estudo transversal, quantitativo, com 42 pacientes assistidos na unidade de nefrologia de um hospital público em Recife/PE, no período de maio a agosto de 2016. Os dados foram coletados por meio de entrevista semiestruturada, analisados por estatística descritiva e inferencial, após aprovação do Comitê de Ética em Pesquisa. Resultados: a autoavaliação de saúde ruim esteve presente em 29 (69%) pacientes, porém sem associação com as características sociodemográficas e clínicas (p<0,05). Conclusão: a alta prevalência da autoavaliação de saúde ruim reflete a necessidade de informações educativas e autocuidado para uma melhor compreensão do estado de saúde e consequente adesão terapêutica.


Objective: to examine health self-perception and associated factors in individuals with chronic kidney disease in dialysis therapy. Method: in this quantitative, cross-sectional study of 42 patients attending the nephrology unit of a public hospital in Recife, Pernambuco, from May to August 2016, data were collected by semistructured interview and analyzed by descriptive and inferential statistics, after approval by the research ethics committee. Results: 29 patients (69%) self-assessed their health as poor, but no association was found with sociodemographic and clinical characteristics (p<0.05). Conclusion: the high prevalence of self-assessed poor health reflects the need for educational information and self-care for a better understanding of health status and consequent adherence to therapy.


Objetivo: analizar la autopercepción de salud y los factores asociados de los individuos con enfermedad renal crónica en terapia dialítica. Método: estudio transversal, cuantitativo, junto a 42 pacientes asistidos en la unidad de nefrología de un hospital público en Recife/Pernambuco, en el período de mayo a agosto de 2016. Los datos fueron recolectados por medio de entrevista semiestructurada, analizados por estadística descriptiva e inferencial, después de la aprobación del Comité de Ética en Investigación.Resultados: la autoevaluación de mala salud estuvo presente en 29 (69%) pacientes, pero sin asociación con las características sociodemográficas y clínicas (p <0,05). Conclusión: la alta prevalencia de la autoevaluación de mala salud refleja la necesidad de informaciones educativas y autocuidado para una mejor comprensión del estado de salud y consecuente adhesión terapéutica


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Health Status Indicators , Renal Dialysis/psychology , Peritoneal Dialysis/psychology , Renal Insufficiency, Chronic , Renal Insufficiency, Chronic/psychology , Diagnostic Self Evaluation , Quality of Life , Self Care , Social Change , Cross-Sectional Studies , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/therapy
9.
Nursing (Säo Paulo) ; 22(258): 3345-3350, nov.2019.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1053407

ABSTRACT

Objetivo: identificar a compreensão dos familiares sobre a importância da técnica de higienização das mãos para a realização de diálise peritoneal em domicílio. Metodologia: estudo descritivo, abordagem qualitativa, método de pesquisa convergente-assistencial. O estudo foi realizado em um Hospital Universitário Estadual do Rio de Janeiro, no setor de Nefrologia. O estudo envolveu 06 familiares que realizam terapia de diálise peritoneal para seus familiares. A coleta de dados ocorreu no período de 13 de julho de 2017 a 31 de agosto de 2017. Principais resultados: dos 06 participantes do estudo 02 realizou-se o saneamento das mãos corretamente de acordo com o vídeo fornecido pela pesquisadora. Conclusão: Percebe-se que, para alguns participantes, ainda há receio e insegurança em relação à execução da técnica de higienização das mãos corretamente.(AU)


Objective: the present study has the following aims: to identify the family members' understanding of the importance of hand hygiene technique for peritoneal dialysis at home. Methods: a descriptive study, qualitative approach, using Convergence - Assistance Research as a method. The study was conducted at a State University Hospital located in the city of Rio de Janeiro, in the Nephrology sector. Sixty family members undergoing peritoneal dialysis therapy of their relative at home participated in the study. Data collection occurred from July 3, 2017 to August 31, 2017.Results: of the 06 participants in study 02 performed the hand hygiene correctly according to the video provided by the researcher. Conclusion: the study reached the proposed objectives; with this it was perceptible that for some participants there is still fear and insecurity about the execution of the technique of hand hygiene correctly.(AU)


Objetivo: identificar el entendimiento de los familiares sobre la importancia de la técnica de higienización de las manos para la realización de la diálisis peritoneal en el domicilio. Metodología: estudio descriptivo, abordaje cualitativo, método la Investigación Convergente-Asistencial. El estudio fue realizado en un Hospital Universitario Estadual de Río de Janeiro, en el sector de Nefrología. Participaron del estudio 06 familiares que realizan la terapia de diálisis peritoneal de su pariente. La recolección de datos ocurrió en el período de 13 de julio de 2017 al 31 de agosto de 2017. Resultados principales: de los 06 participantes del estudio 02 realizaron la higienización de las manos de forma correcta de acuerdo con el vídeo proporcionado por la investigadora. Conclusión principal: Fue perceptible que para algunos participantes aún exista el miedo y inseguridad con relación a la ejecución de la técnica de higienización de las manos de forma correcta. (AU)


Subject(s)
Humans , Hand Disinfection , Peritoneal Dialysis , Hand Hygiene , Patient Education as Topic , Health Promotion
10.
J. bras. nefrol ; 41(3): 345-355, July-Sept. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1040247

ABSTRACT

ABSTRACT Introduction: There is evidence that aldosterone plays a role in the pathogenesis of vascular calcification. The aim of this study was to evaluate the effect of spironolactone, a mineralocorticoid receptor antagonist, on the progression of coronary calcification (CC) in peritoneal dialysis patients and to identify the factors involved in this progression. Methods: Thirty-three patients with a coronary calcium score (CCS) ≥ 30, detected through multi-detector computed tomography (MDCT) and expressed in Agatston units, were randomly assigned to a group receiving 25mg spironolactone per day for 12 months (spironolactone group) and a control group not receiving this drug. The primary outcome was a percentage change in CCS from baseline to end of the study (relative progression), when a further MDCT was conducted. Patients who had progression of CC were compared with those who did not progress. Results: Sixteen patients, seven in the spironolactone group and nine in the control group, concluded the study. The relative progression of the CCS was similar in both groups, 17.2% and 27.5% in the spironolactone and control groups respectively. Fifty-seven percent of the treated patients and 67% of those in the control group presented progression in the CC scores (p = 0.697). Progressor patients differed from non-progressors because they presented higher levels of calcium and low-density lipoprotein cholesterol and lower levels of albumin. Conclusion: In peritoneal dialysis patients, spironolactone did not attenuate the progression of CC. However, large-scale studies are needed to confirm this observation. Disorders of mineral metabolism and dyslipidemia are involved in the progression of CC.


RESUMO Introdução: Existem evidências de que a aldosterona exerça um papel na patogênese da calcificação vascular. O objetivo deste estudo foi avaliar o efeito da espironolactona, um antagonista do receptor mineralocorticoide, na progressão da calcificação coronariana (CC) de pacientes em diálise peritoneal, e identificar os fatores envolvidos nessa progressão. Métodos: Trinta e três pacientes com escore de cálcio coronariano (ECC) ≥ 30, detectado por tomografia computadorizada com múltiplos detectores (TCMD) e expresso em unidades de Agatston, foram randomizados para um grupo que recebeu 25 mg de espironolactona por dia durante 12 meses (grupo espironolactona) e um grupo controle que não recebeu este medicamento. O desfecho primário foi a mudança percentual do ECC do início para o final do estudo (progressão relativa), quando uma nova TCMD foi realizada. Os pacientes que tiveram progressão de CC foram comparados com aqueles que não progrediram. Resultados: Dezesseis pacientes, sete no grupo espironolactona e nove no grupo controle, concluíram o estudo. A progressão relativa do ECC foi semelhante nos dois grupos, 17,2% e 27,5% nos grupos espironolactona e controle, respectivamente. Cinquenta e sete por cento dos pacientes tratados e 67% daqueles no grupo controle apresentaram progressão nos escores de CC (p = 0,697). Os pacientes progressores diferiram dos não progressores porque apresentaram níveis séricos mais elevados de cálcio e LDL-colesterol e menores níveis de albumina. Conclusão: Em pacientes em diálise peritoneal, a espironolactona não atenuou a progressão da CC. No entanto, estudos em grande escala são necessários para confirmar essa observação. Distúrbios do metabolismo mineral e dislipidemia estão envolvidos na progressão da CC.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Spironolactone/therapeutic use , Peritoneal Dialysis , Disease Progression , Mineralocorticoid Receptor Antagonists/therapeutic use , Vascular Calcification/drug therapy , Vascular Calcification/blood , Spironolactone/administration & dosage , Tomography Scanners, X-Ray Computed , Pilot Projects , Calcium/blood , Prospective Studies , Follow-Up Studies , Treatment Outcome , Mineralocorticoid Receptor Antagonists/administration & dosage , Renal Insufficiency, Chronic/therapy , Lost to Follow-Up , Vascular Calcification/pathology , Vascular Calcification/diagnostic imaging , Serum Albumin, Human/analysis , Cholesterol, LDL/blood
11.
J. bras. nefrol ; 41(3): 400-411, July-Sept. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1040253

ABSTRACT

Abstract Hypertension (blood pressure > 140/90 mm Hg) is very common in patients undergoing regular dialysis, with a prevalence of 70-80%, and only the minority has adequate blood pressure (BP) control. In contrast to the unclear association of predialytic BP recordings with cardiovascular mortality, prospective studies showed that interdialytic BP, recorded as home BP or by ambulatory blood pressure monitoring in hemodialysis patients, associates more closely with mortality and cardiovascular events. Although BP is measured frequently in the dialysis treatment environment, aspects related to the measurement technique traditionally employed may be unsatisfactory. Several other tools are now available and being used in clinical trials and in clinical practice to evaluate and treat elevated BP in chronic kidney disease (CKD) patients. While we wait for the ongoing review of the CKD Blood Pressure KIDGO guidelines, there is no guideline for the dialysis population addressing this important issue. Thus, the objective of this review is to provide a critical analysis of the information available on the epidemiology, pathogenic mechanisms, and the main pillars involved in the management of blood pressure in stage 5-D CKD, based on current knowledge.


Resumo A hipertensão (pressão arterial > 140/90 mmHg) é muito comum em pacientes submetidos à diálise regular, com uma prevalência de 70-80%, e apenas a minoria tem controle adequado da pressão arterial (PA). Em contraste com a associação incerta entre de PA pré-dialítica com mortalidade cardiovascular, estudos prospectivos mostraram que a PA interdialítica, registrada como PA domiciliar ou pela monitorização ambulatorial da pressão arterial em pacientes em hemodiálise, está mais relacionada à mortalidade e eventos cardiovasculares. Embora a PA seja medida com frequência no ambiente de tratamento de diálise, aspectos relacionados à técnica de medição tradicionalmente empregada podem ser insatisfatórios. Várias outras ferramentas estão agora disponíveis, e estão sendo usadas em ensaios clínicos e na prática clínica para avaliar e tratar a PA elevada em pacientes com doença renal crônica (DRC). Enquanto esperamos pela revisão das diretrizes do KIDGO para a pressão sanguíneana DRC, não há nenhuma diretriz para a população em diálise abordando essa importante questão. Assim, o objetivo desta revisão é fornecer uma análise crítica das informações disponíveis sobre a epidemiologia, os mecanismos patogênicos e os principais pilares sustentadores do manejo da pressão arterial no estágio 5-D da DRC, com base no conhecimento atual.


Subject(s)
Humans , Peritoneal Dialysis , Hypertension/therapy , Hypertension/epidemiology , Prevalence , Risk Factors , Blood Pressure Monitoring, Ambulatory , Diet, Sodium-Restricted , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Hypertension/diagnosis , Hypertension/physiopathology , Antihypertensive Agents/therapeutic use
12.
J. bras. nefrol ; 41(3): 427-432, July-Sept. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1040255

ABSTRACT

Abstract Methotrexate is an effective medication to control several diseases; however, it can be very toxic, being myelosuppression one of its main adverse effects, which increases in severity and frequency in patients with renal failure. We present the case of a 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis, under treatment with peritoneal dialysis, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopenia with mucositis that improved with support measures and multiple-exchange peritoneal dialysis. We reviewed 20 cases published to date of pancytopenia associated with methotrexate in patients on dialysis and found high morbidity and mortality, which is why its use in this type of patient is not recommended. However, when this complication occurs, a therapeutic option could be the use of multiple-exchange peritoneal dialysis in addition to supportive therapy for drug-related toxicity, although it is recognized that studies are required to show the role of multiple-exchange peritoneal dialysis in the removal of this medication.


Resumo Apesar de sua toxicidade, o metotrexato é um medicamento eficaz no controle de várias doenças. A mielossupressão, um de seus principais efeitos adversos, aumenta em gravidade e frequência nos pacientes com insuficiência renal. Apresentamos o caso de um homem de 68 anos de idade com doença renal terminal relacionada à vasculite associada ao ANCA em diálise peritoneal, que recebeu a medicação em dose baixa em função da atividade da doença e que teve como complicação pancitopenia grave com mucosite, tratada com medidas de suporte e diálise peritoneal com múltiplas trocas. Revisamos 20 casos publicados até o presente momento sobre pancitopenia associada a metotrexato em pacientes em diálise. Foi identificada alta morbidade e mortalidade, razão pela qual seu uso nesse tipo de paciente não é recomendado. No entanto, quando esta complicação ocorre, uma opção terapêutica pode ser o uso de diálise peritoneal com múltiplas trocas, além da terapia de suporte para toxicidade medicamentosa. Maiores estudos são necessários para demonstrar o papel da diálise peritoneal com múltiplas trocas na remoção desse medicamento.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Vasculitis/drug therapy , Methotrexate/adverse effects , Methotrexate/therapeutic use , Peritoneal Dialysis/methods , Folic Acid Antagonists/adverse effects , Folic Acid Antagonists/therapeutic use , Kidney Failure, Chronic/therapy , Pancytopenia/etiology , Pancytopenia/therapy , Shock, Septic/etiology , Shock, Septic/drug therapy , Methotrexate/blood , Treatment Outcome , Mucositis/etiology , Mucositis/drug therapy , Folic Acid Antagonists/blood , Anti-Bacterial Agents/therapeutic use
13.
Rev. enferm. Inst. Mex. Seguro Soc ; 27(3): 146-153, Jul-Sep 2019. tab
Article in Spanish | LILACS (Americas), BDENF | ID: biblio-1047303

ABSTRACT

Introducción: el empoderamiento es un factor clave para la atención de personas con insuficiencia renal crónica (IRC) que se someten a diálisis peritoneal; su finalidad es la responsabilidad del paciente sobre su enfermedad. Objetivo: evaluar el nivel de empoderamiento que tiene el paciente con IRC sobre el cuidado de la diálisis peritoneal. Métodos: estudio analítico, transversal, en el que participaron 174 pacientes con diálisis peritoneal. Se utilizó un instrumento con 24 ítems con respuestas de opción múltiple, con el que se evaluó el nivel de empoderamiento en alto, medio y bajo. Se utilizó estadística descriptiva y la prueba de chi cuadrada. Resultados: 57.5% de los pacientes tuvo un nivel medio de empoderamiento. En relación con las dimensiones de empoderamiento, los pacientes tuvieron 85.1% en conocimiento, 88.1% en autocuidado, 83% en toma de decisiones y 81.9% en obtención de información, por lo que recayeron también en un nivel medio. La asociación de empoderamiento con edad, escolaridad y redes de apoyo tuvo una p < 0.001. Conclusiones: el nivel de empoderamiento de los pacientes en el cuidado de la diálisis peritoneal fue medio, por lo que es necesario incrementarlo, a fin de mejorar la calidad de vida.


Introduction: Empowerment is a key factor for the care of people with chronic renal insufficiency (CRI) who undergo peritoneal dialysis; its main purpose is the patients' responsibility for their disease. Objective: To assess the level of empowerment that the patient with CRI has about the care of peritoneal dialysis. Methods: Analytical, cross-sectional study, which induded 174 patients with peritoneal dialysis. It was used an instrument with 24 items, with multiple-choice questions, which assessed the level of empowerment as high, médium and low. Descriptive statistics and chi-square test were used. Results: 57.5% of patients had a médium level of empowerment. Conceming empowerment dimensions, patients presented 85.1% in knowledge, 88.1% in self-care, 83% in decision-making and 81.9% in obtaining information, which are considered médium levels as well. The association of empowerment with age, schooling and support networks produced a p valué < 0.001. Conclusions: The patients' level of empowerment about peritoneal dialysis was médium, which is why it is necessary to increase it, in order to improve the quality of life.


Subject(s)
Humans , Patient Participation , Quality of Life , Analytical Methods , Cross-Sectional Studies , Peritoneal Dialysis , Renal Insufficiency, Chronic , Mexico
14.
J. bras. nefrol ; 41(2): 208-214, Apr.-June 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1012536

ABSTRACT

Abstract Introduction: Having national data on chronic dialysis is essential in treatment planning. Objective: To present data of the survey from the Brazilian Society of Nephrology on patients with chronic kidney disease on dialysis in July 2017. Methods: Data was collected from dialysis units in Brazil. The data collection was done using a questionnaire completed online by the dialysis units. Results: Two hundred and ninety-one centers (38.4%) answered the questionnaire. In July 2017, the estimated total number of dialysis patients was 126,583. National estimates of prevalence and incidence rates of dialysis patients per million population (pmp) were 610 (range: 473 in the North region and 710 in the Midwest) and 194, respectively. The incidence rate of new dialysis patients with diagnosis of diabetic nephropathy was 77 pmp. The annual gross mortality rate was 19.9%. Of the prevalent patients, 93.1% were on hemodialysis and 6.9% on peritoneal dialysis, with 31,226 (24%) on the waiting list for renal transplantation. Venous catheter was used as access in 22.6% of patients on hemodialysis. The prevalence rate of positive serology for hepatitis C continued with a tendency to decrease (3.3%). Conclusion: The absolute number of patients and rates of incidence and prevalence on dialysis continued to increase; the mortality rate tended to rise. There were obvious regional and state discrepancies in these rates.


Resumo Introdução: Dados nacionais sobre diálise crônica são fundamentais no planejamento do tratamento. Objetivo: Apresentar dados do inquérito da Sociedade Brasileira de Nefrologia sobre os pacientes com doença renal crônica em tratamento dialítico em julho de 2017. Métodos: Levantamento de dados de unidades de diálise do país. A coleta de dados foi feita utilizando questionário preenchido on-line pelas unidades de diálise. Resultados: 291 (38,4%) centros responderam ao questionário. Em julho de 2017, o número total estimado de pacientes em diálise foi de 126.583. As estimativas nacionais das taxas de prevalência e de incidência de pacientes em tratamento dialítico por milhão da população (pmp) foram 610 (variação: 473 na região Norte e 710 no Centro-Oeste) e 194, respectivamente. A taxa de incidência de novos pacientes em diálise com diagnóstico de nefropatia diabética foi de 77 pmp. A taxa anual de mortalidade bruta foi de 19,9%. Dos pacientes prevalentes, 93,1% estavam em hemodiálise e 6,9% em diálise peritoneal, com 31.226 (24%) em fila de espera para transplante. Cateter venoso era usado como acesso em 22,6% dos pacientes em hemodiálise. A taxa de prevalência de sorologia positiva para hepatite C continua a mostrar tendência para redução (3,3%). Conclusão: O número absoluto de pacientes e as taxas de incidência e prevalência em diálise continuam a aumentar; a taxa de mortalidade tendeu a elevar-se. Há discrepâncias regionais e estaduais evidentes nessas taxas.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Surveys and Questionnaires , Peritoneal Dialysis , Renal Insufficiency, Chronic/therapy , Renal Insufficiency, Chronic/epidemiology , Brazil/epidemiology , Incidence , Prevalence , Mortality/trends , Kidney Transplantation , Diabetic Nephropathies/therapy , Diabetic Nephropathies/epidemiology
15.
Saúde Soc ; 28(1): 275-286, jan.-mar. 2019.
Article in Spanish | LILACS (Americas) | ID: biblio-991668

ABSTRACT

Resumen Este trabajo se propone identificar los obstáculos que enfrentan individuos jóvenes en tratamiento de diálisis peritoneal, así como examinar las estrategias de afrontamiento que utilizan en la atención renal. Para ello, se llevó a cabo un estudio cualitativo desde una perspectiva crítico-interpretativa. Participaron 12 jóvenes con insuficiencia renal y en tratamiento de diálisis peritoneal, viviendo en Guadalajara, México. Mediante un muestreo por bola de nieve, se seleccionaron siete hombres y cinco mujeres. La información se obtuvo mediante entrevistas narrativas y observación participante, además de conversaciones en WhatsApp y Facebook. Se hizo análisis de contenido. Además del consentimiento informado, se aseguró el anonimato y la confidencialidad de la información. Los resultados desvelan cuatro ejes temáticos que emergen del análisis de la información: Enfrentando dificultades económicas, Viviendo las deficiencias de los servicios de salud, Interferencias en la comunicación con los profesionales sanitarios y En búsqueda permanente de estrategias. Múltiples estrategias se emplean para enfrentar los problemas económicos, la falta de información y el control emocional. Se observó que la falta de recursos económicos es el principal obstáculo que enfrentan los jóvenes en diálisis. Estos jóvenes impulsan estrategias, junto con familiares y sus pares, para afrontar las dificultades.


Abstract This study aims at identifying the obstacles faced by young individuals on peritoneal dialysis treatment, as well as to examine the coping strategies they use in renal care. A qualitative study was carried out from a critical-interpretative approach. Participants were 12 young people with kidney failure, under peritoneal dialysis treatment, who lived in Guadalajara, Mexico. Using a snowball sampling, seven men and five women were selected. The data was obtained through narrative interviews and participant observation, as well as conversations on WhatsApp and Facebook. Content analysis was conducted. In addition to informed consent, anonymity and confidentiality of the information were ensured. Four main themes emerged from data analysis: Facing economic difficulties, Living the health services deficiencies, Interference in communication with health professionals, and The permanent search for strategies. Several strategies are used mainly to solve economic problems, lack of information and emotional control. Lack of economic resources is the main obstacle faced by young people under dialysis treatment. Young people employ strategies together with family members and their peers to face the difficulties encountered.


Subject(s)
Humans , Male , Female , Adaptation, Psychological , Peritoneal Dialysis , Kidney Diseases , Mexico , Qualitative Research , Kidney Diseases/psychology , Kidney Diseases/therapy
16.
Rev. nefrol. diál. traspl ; 39(1): 46-49, ene. 2019. ilus, tab
Article in Spanish | LILACS (Americas) | ID: biblio-1007082

ABSTRACT

Se comunica un caso de hidrotórax agudo derecho en un adolescente de 13 años con Insuficiencia renal crónica terminal (IRCT) en Diálisis Peritoneal Crónica Ambulatoria (DPCA) de sostén. Es una complicación poco frecuente, siendo en nuestra experiencia en el Programa de DPCA del Hospital del Niño Jesús en 12 años de duración, el primer caso. Describimos su evolución, diagnóstico y resolución


A case of right acute hydrotorax is reported in a 13 years old boy with terminal chronic renal failure in CPD (chronic peritoneal diálysis); it is a rare complication and in our experience in the chronic peritoneal dialysis program in Hospital del niño Jesus, Tucuman, in 12 years of duration is the first case. We inform the evolution, diagnosis and resolution.


Subject(s)
Humans , Male , Adolescent , Renal Dialysis , Peritoneal Dialysis , Hydrothorax , Kidney Failure, Chronic
17.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-775237

ABSTRACT

OBJECTIVE@#To investigate the associations between mean arterial pressure (MAP) and mortality in patients with peritoneal dialysis (PD).@*METHODS@#A total of 1737 patients with terminal renal diseases under PD in the First Affiliated Hospital of Zhejiang University from 2008 to 2016 were enrolled. Patients were followed up for 33.0(19.3, 52.4) months. The mean arterial pressure over the first 3 months of PD therapy were calculated. All-cause death and cardiovascular death were assessed using Cox regression models adjusted for demographics, laboratory measurements, comorbid conditions and antihypertensive medications.@*RESULTS@#During the follow-up, 208 patients died, among which 95(45.7%) patients died of cardiovascular causes. Compared with patients with MAP >95-<120 mmHg, patients with MAP ≤ 95 mmHg were associated with significantly higher risk of all-cause death (=1.40,95%:1.01-1.93,<0.05); patients with MAP ≥ 120 mmHg were associated with significantly higher risk of all-cause (=2.12,95%:1.32-3.40, <0.01) and cardiovascular morality (=2.55, 95%:1.38-4.70, <0.01). MAP presents a U-shaped association with all-cause mortality and a J-shaped association with cardiovascular mortality.@*CONCLUSIONS@#Both high MAP and low MAP are associated with higher risk of mortality in PD patients.


Subject(s)
Arterial Pressure , Humans , Kidney Failure, Chronic , Mortality , Pathology , Peritoneal Dialysis , Renal Dialysis , Risk Factors
18.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-773552

ABSTRACT

OBJECTIVE@#To explore the impact of dietary sodium-intake on residual renal function in patients undergoing peritoneal dialysis (PD).@*METHODS@#Thirty-three patients on PD with stable dialysis were regularly followed up for 12 months. The daily sodium intake of the patients was calculated based on the 3-day dietary record. Based on the mean daily sodium intake, the patients enrolled were divided into low-salt group (sodium intake≤3.0 g/day, 19 patients) and high-salt group (sodium intake>3.0 g/day, 14 patients). The baseline data of the patients were recorded, and the indicators of residual renal function and peritoneal function were regularly tested. The patients were followed-up at 3-month intervals, and their urine volume, peritoneal ultrafiltration volume and other clinical indicators were recorded and the biochemical indexes were detected to evaluate the changes in the residual renal function and peritoneal function.@*RESULTS@#There was a positive correlation between the total sodium excretion and dietary sodium intake in these patients (=0.536, =0.0013), and sodium excretion by dialysis was positively correlated with their sodium intake (=0.901, =0.000). Regression analysis suggested that the total sodium excretion was correlated with dietary sodium intake (β=0.416, 95% : 0.170-0.666; < 0.0018); sodium excretion by dialysis was associated with dietary sodium intake (β=0.489, 95% : 0.395-0.582; < 0.001). The residual renal function was reduced by 17.48±11.22 L /(w·1.73 m) in the low-salt group, as compared to 30.20±18.30 L /(w·1.73 m) in the high-salt group (=0.032). The reduction in the residual renal function was correlated with sodium intake in the PD patients (=0.409, =0.018). Multivariate regression analysis showed that sodium intake was an independent factor contributing to the reduction of residual renal function (β=14.646, 95% CI 7.426-21.866, < 0.001).@*CONCLUSIONS@#Sodium excretion by PD in patients with continuous ambulatory PD is positively correlated with their dietary sodium intake, which contribute to the decrease of residual renal function. A high dietary sodium intake may accelerate the reduction of residual renal function in these patients.


Subject(s)
Humans , Kidney , Peritoneal Dialysis , Prospective Studies , Sodium, Dietary
19.
Article in English | WPRIM (Western Pacific) | ID: wprim-760726

ABSTRACT

Aluminum (Al) is the third most abundant element in the earth's crust and is omnipresent in our environment, including our food. However, with normal renal function, oral and enteral ingestion of substances contaminated with Al, such as antacids and infant formulae, do not cause problems. The intestine, skin, and respiratory tract are barriers to Al entry into the blood. However, contamination of fluids given parenterally, such as parenteral nutrition solutions, or hemodialysis, peritoneal dialysis or even oral Al-containing substances to patients with impaired renal function could result in accumulation in bone, parathyroids, liver, spleen, and kidney. The toxic effects of Al to the skeleton include fractures accompanying a painful osteomalacia, hypoparathyroidism, microcytic anemia, cholestatic hepatotoxicity, and suppression of the renal enzyme 25-hydroxyvitamin D-1 alpha hydroxylase. The sources of Al include contamination of calcium and phosphate salts, albumin and heparin. Contamination occurs either from inability to remove the naturally accumulating Al or from leeching from glass columns used in compound purification processes. Awareness of this long-standing problem should allow physicians to choose pharmaceutical products with lower quantities of Al listed on the label as long as this practice is mandated by specific national drug regulatory agencies.


Subject(s)
Aluminum , Anemia , Antacids , Calcium , Eating , Glass , Heparin , Humans , Hypoparathyroidism , Infant Formula , Intestines , Kidney , Leeching , Liver , Osteomalacia , Parathyroid Glands , Parenteral Nutrition Solutions , Peritoneal Dialysis , Pharmaceutical Preparations , Renal Dialysis , Respiratory System , Salts , Skeleton , Skin , Spleen
20.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-759728

ABSTRACT

Metastatic calcinosis cutis refers to the deposition of calcium salts in normal tissue secondary to an underlying defect in calcium and/or phosphate metabolism. It commonly affects periarticular areas in patients with chronic renal failure. We report a case of a 51-year-old man with a past medical history of peritoneal dialysis for chronic renal failure, who presented with multiple yellowish nodules on his right thumb. In view of the asymptomatic non-inflamed fluctuating nodules, the differential diagnoses included bacterial, tuberculous, atypical mycobacterial, or fungal infections. Histopathological and radiological examinations revealed calcifications in the right thumb and shoulder with elevated serum phosphorus and parathyroid hormone levels. The lesions improved after the patient was switched from peritoneal dialysis to hemodialysis. We report a case of metastatic calcinosis cutis in a patient with chronic renal failure. We emphasize the importance of imaging for accurate diagnosis and follow-up of calcinosis cutis and that hemodialysis scores over peritoneal dialysis in the treatment of this condition.


Subject(s)
Calcinosis , Calcium , Diagnosis , Diagnosis, Differential , Follow-Up Studies , Humans , Kidney Failure, Chronic , Metabolism , Middle Aged , Parathyroid Hormone , Peritoneal Dialysis , Phosphorus , Renal Dialysis , Salts , Shoulder , Thumb
SELECTION OF CITATIONS
SEARCH DETAIL