Subject(s)
Body Weight , Hypertension/prevention & control , Kidney Failure, Chronic/therapy , Renal Dialysis/methods , Aged , Antihypertensive Agents/therapeutic use , Body Water , Drug Utilization , Female , Humans , Hypertension/complications , Hypertension/drug therapy , Hypotension/etiology , Hypotension/prevention & control , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/physiopathology , Male , Patient Acceptance of Health Care , Renal Dialysis/adverse effects , Time FactorsABSTRACT
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Subject(s)
Humans , Renal Dialysis/methods , Renal Insufficiency, Chronic/therapy , Dosage/methodsABSTRACT
A partir de los años 90, diversos estudios han permitido disponer de datos sobre Calidad de Vida Relacionada con la Salud (CVRS) en pacientes con enfermedad renal crónica(ERC) en estadios previos al inicio de tratamiento renal sustitutivo (TRS). Las caracteristicas de estos pacientes(Fuerza de Recomendación C) son: Los pacientes con ERC presentan un deterioro en su CVRS cuando se les compara con la población general. El deterioro se asocia a diversas variables socio demográficas: edad, sexo, estado civil, nivel de educación e ingresos económicos. El deterioro se explica en parte por las enfermedades que causan la ERC (hipertensión y diabetes), las patologías asociadas (especialmente cardiovasculares) y las complicaciones de la ERC (anemia y desnutrición-inflamación). El descenso progresivo del filtrado glomerular (FG) se asocia a un deterioro progresivo de la CVRS, así como aun aumento de la frecuencia y severidad de ciertos síntomas y del impacto (distrés psicológico) debido a los mismos. Las dimensiones físicas se afectan más que las mentales y sociales. Las alteraciones mentales de los pacientes con ERC pueden resumirse como: Existe una asociación entre niveles altos de ansiedad y niveles bajos de sensación de coherencia con una disminución del bienestar que, a su vez, influye en la capacidad funcional para actividades de la vida diaria. La afectación psicológica debida a los síntomas aumenta a medida que empeora el FG. Existe un alto nivel de correlación entre percepción de (..) (AU)
From the 1990s, various studies have provided data on health-related quality of life (HRQOL) in patients with chronic kidney disease(CKD) in stages previous to the initiation of kidney replacement therapy (KRT). The characteristics of these patients (Strength of Recommendation C) are: Patients with CKD have a deterioration in their HRQOL when compared with the general population. This deterioration is associated with various sociodemographic variables: age, gender, marital status, educational level and income. The deterioration is partly explained by the diseases that cause CKD (hypertension and diabetes), associated comorbid conditions(especially cardiovascular) and complications of CKD(anemia and malnutrition-inflammation). The progressive decline in glomerular filtration rate (GFR) is associated with a progressive deterioration of HRQOL, as well as an increase in the frequency and severity of certain symptoms and the impact (psychological distress) they cause. Physical dimensions are more affected than mental or social dimensions. Mental disturbances in patients with CKD can be summarized as follows: There is an association between high levels of anxiety and low levels of sense of coherence with a reduction in wellbeing that in turn affects functional capacity for activities of (..) (AU)
Subject(s)
Humans , Renal Insufficiency, Chronic/psychology , Quality of LifeABSTRACT
From the 1990s, various studies have provided data on health-related quality of life (HRQOL) in patients with chronic kidney disease (CKD) in stages previous to the initiation of kidney replacement therapy (KRT). The characteristics of these patients (Strength of Recommendation C) are: Patients with CKD have a deterioration in their HRQOL when compared with the general population. This deterioration is associated with various sociodemographic variables: age, gender, marital status, educational level and income. The deterioration is partly explained by the diseases that cause CKD (hypertension and diabetes), associated comorbid conditions (especially cardiovascular) and complications of CKD (anemia and malnutrition-inflammation). The progressive decline in glomerular filtration rate (GFR) is associated with a progressive deterioration of HRQOL, as well as an increase in the frequency and severity of certain symptoms and the impact (psychological distress) they cause. Physical dimensions are more affected than mental or social dimensions. Mental disturbances in patients with CKD can be summarized as follows: - There is an association between high levels of anxiety and low levels of sense of coherence with a reduction in wellbeing that in turn affects functional capacity for activities of daily living. - Psychological impairment from symptoms increases as GFR worsens. - This is a high level of correlation between perception of disease, depression and satisfaction with life. - Impairment of mental dimensions is greater in male, young, divorced, unemployed, smoker, and obese patients and in those who take more medication and have greater comorbidity. - Impairment of mental dimensions is negatively associated with albumin levels and hemoglobin. The recommended questionnaire for measurement of HRQOL in this type of patients is the SF-36. The SF-12 can be used as a shorter alternative and is suitable for evaluation of groups of patients.
Subject(s)
Kidney Diseases/psychology , Quality of Life , Chronic Disease , Disease Progression , Humans , Kidney Diseases/diagnosis , Surveys and QuestionnairesABSTRACT
La policitemia vera (PV) es un proceso mieloproliferativo cuyas manifestaciones clínicas pueden ser muy variadas, desde ser un hallazgo en las pruebas de laboratorio hasta debutar de forma más grave con fenómenos trombóticos. Los pacientes con policitemia primaria son a veces hipertensos y algunos pacientes hipertensos esenciales tienen una poliglobulia relativa que puede resolverse cuando se produce un descenso de la tensión arterial (TA). Presentamos el caso de un paciente de 16 años que fue diagnosticado de PV a raíz de un estudio de hipertensión arterial (HTA) de reciente aparición. La monitorización ambulatoria de 24 horas de la tensión arterial (MAPA) mostró un patrón de HTA secundaria. Las cifras tensionales y los resultados de la MAPA se normalizaron al iniciar tratamiento del proceso hematológico mediante eritrocitoaféresis. La HTA como manifestación clínica inicial de la PV es muy poco frecuente. La etiología de la HTA en esta enfermedad es controvertida. La disfunción endotelial y la elevación del hematocrito parecen desempeñar un papel importante
Polycythemia vera (PV) is a myeloproliferative disorder with many different kinds of clinical presentations, from a simple laboratory finding up to very severe thrombotic phenomena. Patients with primary PV are sometimes hypertensive, while some patients with essential hypertension may have relative polyglobulia which resolves after blood pressure control. We present the case of a 16 years old man who was diagnosed of PV while he was been investigated because of recently discovered high blood pressure (BP). 24 hour ambulatory BP monitoring showed a nondipper pattern more frecuently seen in secondary forms of hypertension. After the initiation of PV treatment with arythroapheresis, BP values and the results of hour ambulatory BP monitoring became normal. High blood pressure as the first clinical sign of PV is rarely seen. The etiology of hypertension in PV is a controversial issue; endothelial dysfunction and the elevation of hematocrit appear to play role
