Calcificaciones vasculares y valvulares en pacientes en hemodiálisis crónica / Vascular and valvular calcifications in chronic hemodialysis patients

Introducción: las calcificaciones vasculares y valvulares son un hallazgo común en los pacientes en diálisis y se vinculan con una incrementada morbi-mortalidad. Varios métodos radiológicos (TAC multicorte y con emisión de electrones) han sido utilizados para investigar la presencia de calcificaciones vasculares en esta población, pero solo unos pocos trabajos se han focalizado en la radiología simple. Objetivos: Los objetivos de este estudio son evaluar calcificaciones vasculares mediante índice de Kauppila en pacientes prevalentes en hemodiálisis, identificar factores de riesgo vinculados con las mismas y establecer su asociación con calcificación de válvulas cardiacas. Material y métodos: Se estudiaron 95 pacientes estables en hemodiálisis durante un periodo igual o mayor a 6 meses. A todos se les realizó Rx simple perfil de abdomen para evaluar calcificación de la aorta abdominal mediante índice de Kauppila y ecocardiograma bidimensional para detectar calcificaciones valvulares. Se recolectaron datos sobre sexo, edad, diabetes, HTA, tabaquismo, dislipemia y metabolismo óseo-mineral. Resultados: Se demostraron calcificaciones vasculares en el 64,5 % de los pacientes. El índice de Kauppila promedio fue 6,25 La edad y el tiempo en diálisis correlacionaron con calcificación vascular. En 31,6 % de los individuos se objetivaron calcificaciones valvulares, las cuales presentaron asociación significativa con diabetes e índice de Kauppila. Conclusiones: Las calcificaciones vasculares y valvulares fueron frecuentes en la población estudiada. El índice de Kauppila correlacionó con edad, tiempo en diálisis y calcificaciones valvulares. La calcificación de válvulas cardiacas se asoció con diabetes.

Introduction: vascular and valvular calcifications are a frequent complication in dialyzed patients and are connected to an increased morbi-mortality. Many radiological methods (TAC multiple slices and with electrons emission) have been used to investigate the presence of vascular calcifications in this population, but only few works have been focused on simple radiology. Objectives: The objectives of this work are to evaluate vascular calcifications by means of Kauppila index in hemodialysis prevalent patients, identify linked risk factors and determine their association with heart valves calcification. Methods: 95 stable patients under hemodialysis were surveyed during a period of 6 months longer. Abdominal Rx simple profile were performed on all patients to evaluate calcification of abdominal aorta by Kauppila index and twodimensional echocardiogram to detect valvular calcifications. Data were collected about sex, age, diabetes, Hypertension, tabaquism, dislipemia and bone-mineral metabolism. Results: 64.5% of the patients showed vascular calcifications. Average Kauppila index was 6.25. Age and time on dialysis correlated with vascular calcifications. In 31.6 % of individuals valvular calcifications were found, which presented significant association with diabetes and Kauppila Index. Conclusions: Vascular and valvular calcifications were frequent in the surveyed population. Kauppila index correlated with age, time on dialysis and valvular calcifications. Heart valves calcification was associated with diabetes.

Efecto de megadosis intravenosas de ácido fólico sobre la homocisteína en pacientes en hemodiálisis / Effects of intravenous folic acid megadosis on homocysteine of hemodialyis patients

La megadosis de ácido fólico intravenoso postdiálisis es efectiva para reducir la homocisteína sérica y su magnitud se asocia a la eficiencia dialítica aplicada

Lipid abnormalities in chronic renal failures undergoing hemodialysis

Lipid abnormalities are common in patients with renal disease, probably contributing to the high incidence of cardiovascular diseases in this population. In this study we determined the plasma and erythrocyte lipid profile in patients with chronic renal failure (CRF) along 30 months under hemodialysis. In the same patients the influence of cuprophane and polysulphone dialysis membranes on the fatty acid pattern of plasma and erythrocytes, before and after dialysis, was also studied. Fluidity in erythrocyte membranes was also assessed by diphenylhexatriene (DPH) fluorescence polarization measurements. Triglyceride levels were increased in the plasma and in erythrocyte membranes of CRF patients compared to healthy subjects. Plasma polyunsaturared fatty acids decreased whereas palmitic and monounsaturated acids increased in CRF patients. No changes were observed in either the fatty acid profile or DPH fluorescence anisotropy of erythrocyte membranes. The lipid composition abnormalities persisted after 18 months and they became more notorious after 30 months. Neither the plasma nor the erythrocyte membrane lipid pattern changed in CRF patients during the dialysis session, regardless of the dialysis membrane used. We conclude that CRF patients under regular hemodialysis evidence a gradual deteriorarion in the fatty acid and triglyceride abnormalities, a finding that might be relevant to the risk of cardiovascular disease in this setting.