RESUMO
The timing for dialysis initiationis still debated. The aim of this study was to compare mortality rates, using a propensity-score approach, in dialysis patients with early or late starts. From January 2000 to June 2009, incident adult patients (n = 836) starting dialysis for end-stage renal disease (ESRD) were enrolled. The patients were assigned to either an early- or late-start group depending on the initiation time of the dialysis. After propensity-score-basedmatching, 450 patients remained. At the initiation of dialysis, the mean estimated glomerular filtration rate (eGFR) was 11.1 mL/min/1.73 m2 in the early-start group compared with 6.1 mL/min/1.73 m2 in the late-start group. There were no significant differences in survival between the patients in the early- and late-start groups (Log rank tests P = 0.172). A higher overall mortality risk was observed in the early-start group than in the late-start group for the patients aged > or = 70 yr (hazard ratio [HR]: 3.29; P = 0.048) and/or who had albumin levels > or = 3.5 g/dL (HR: 2.53; P = 0.046). The survival of the ESRD patients was comparable between the patients in the early and late-start groups. The time to initiate dialysis should be determined based on clinical findings as well as the eGFR.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Etários , Taxa de Filtração Glomerular , Estimativa de Kaplan-Meier , Falência Renal Crônica/diagnóstico , Pontuação de Propensão , Modelos de Riscos Proporcionais , Diálise Renal , Fatores de Risco , Albumina Sérica/análise , Fatores de TempoRESUMO
Exercise-induced hematuria is a phenomenon occurring in subjects who participate in strenuous exercise. Rapid resolution is an important feature of exercise-induced hematuria. We report here a case of exercise-induced hematuria presenting as gross hematuria lasting 1 week in a 19-year-old male patient. Gross hematuria developed after strenuous exercise about 3 years ago. Three months ago, recurrent gross hematuria was lasting 1 week, regardless of exercise intensity. Compression of the left renal vein between the aorta and superior mesenteric artery, without prominent venous collaterals, was detected by computed tomography. However, no abnormalities were detected by renal venography, arteriography or kidney biopsy. Exercise-induced hematuria occurs with a high incidence, but is self-limiting. In contrast, recurrent and gross hematuria can be associated with bladder carcinoma or vascular abnormality. This should be kept in mind, and urological evaluations such as cystoscopy and angiography are necessary in gross and recurrent hematuria.
Assuntos
Humanos , Masculino , Adulto Jovem , Angiografia , Aorta , Biópsia , Cistoscopia , Hematúria , Incidência , Rim , Artéria Mesentérica Superior , Flebografia , Veias Renais , Bexiga UrináriaRESUMO
Exercise-induced hematuria is a phenomenon occurring in subjects who participate in strenuous exercise. Rapid resolution is an important feature of exercise-induced hematuria. We report here a case of exercise-induced hematuria presenting as gross hematuria lasting 1 week in a 19-year-old male patient. Gross hematuria developed after strenuous exercise about 3 years ago. Three months ago, recurrent gross hematuria was lasting 1 week, regardless of exercise intensity. Compression of the left renal vein between the aorta and superior mesenteric artery, without prominent venous collaterals, was detected by computed tomography. However, no abnormalities were detected by renal venography, arteriography or kidney biopsy. Exercise-induced hematuria occurs with a high incidence, but is self-limiting. In contrast, recurrent and gross hematuria can be associated with bladder carcinoma or vascular abnormality. This should be kept in mind, and urological evaluations such as cystoscopy and angiography are necessary in gross and recurrent hematuria.
Assuntos
Humanos , Masculino , Adulto Jovem , Angiografia , Aorta , Biópsia , Cistoscopia , Hematúria , Incidência , Rim , Artéria Mesentérica Superior , Flebografia , Veias Renais , Bexiga UrináriaRESUMO
Accurate measurement of the volume status in hemodialysis patients is important as it can affect mortality. However, no studies have been conducted regarding volume management in cases where a sudden change of body fluid occurs, such as during puerperium in hemodialysis patients. This report presents a case in which the patient was monitored for her body composition and her volume status was controlled using a body composition monitor (BCM) during the puerperal period. This case suggests that using a BCM for volume management may help maintain hemodynamic stability in patients with a rapidly changing volume status for a short term period, such as during puerperium.