ABSTRACT
No disponible
Subject(s)
Humans , Thermography/instrumentation , Smartphone , Skin Temperature , Catheterization/methods , Renal Dialysis/methods , Catheter-Related Infections/diagnostic imaging , Pilot Projects , Reproducibility of ResultsABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Renal Insufficiency, Chronic/therapy , Renal Dialysis , Quality of Life , Age FactorsABSTRACT
INTRODUCCIÓN: Los índices plaquetas-linfocito (IPL) y neutrófilo-linfocito (INL) son marcadores emergentes de inflamación. La resistencia a la eritropoyetina está relacionada con una mayor morbimortalidad en los pacientes con enfermedad renal crónica y está influida, entre otros factores, por la inflamación. Por lo tanto, cabría esperar una relación entre estos marcadores y la resistencia a la eritropoyetina. MÉTODOS: Estudio transversal-multicéntrico. Se estudiaron los registros de las sesiones de hemodiálisis de 534 pacientes pertenecientes a 4 de nuestros centros de diálisis. Se excluyó a 137 pacientes, por lo que el número final de pacientes estudiado fue de 397. Se calculó el INL, el IPL y, como medida de resistencia a la eritropoyetina, se calculó el índice de respuesta a la eritropoyetina (IRE). RESULTADOS: Se dividió el IRE en cuartiles y se compararon con las medias de INL e IPL de los 4 grupos, siendo estas diferencias estadísticamente significativas (p = 0,00058). En los análisis de regresión, el valor de INL pudo predecir el IRE de forma significativa (p < 0,0001) (R2 = 0,029). Asimismo, el valor de IPL también predijo el IRE de forma significativa (p < 0,0001) (R2 = 0,103). La capacidad del IPL para predecir resistencia a la eritropoyetina se midió con el área bajo la curva ROC (AUC = 0,681) (IC 95%: 0,541-0,821). Un punto de corte de IPL de 125,5 resultaría en un 80,95% de sensibilidad y 42,82% de especificidad. CONCLUSIONES: Tanto el IPL como el INL podrían considerarse unos aceptables marcadores de resistencia a la eritropoyetina. El IPL resultó ser un mejor predictor que el INL para el IRE
INTRODUCTION: The platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte (NLR) ratios are emerging markers of inflammation. Erythropoietin resistance is associated with increased morbidity and mortality in patients with chronic kidney disease and is influenced by inflammation, among other factors. Therefore, it would be reasonable to expect a relationship between these markers and erythropoietin resistance. METHODS: Multicentre cross-sectional study. The records of the haemodialysis sessions of 534 patients belonging to four of our dialysis centres were studied. 137 patients were excluded, so the final number of patients studied was 397. NLR, PLR and the erythropoietin resistance index (ERI) were calculated. RESULTS: The ERI was divided into quartiles and compared with the mean NLR and PLR of the four groups, with these differences being statistically significant (p = 0.00058). In the regression analysis, the NLR value was able to predict ERI significantly (p < 0.0001) (R2 = 0.029). The PLR value also predicted ERI significantly (p < 0.0001) (R2 = 0.103). The ability of PLR to predict erythropoietin resistance was measured with the area under the ROC curve (AUC = 0.681) (95% CI, 0.541-0.821). A PLR cut-off point of 125.5 would result in a sensitivity of 80.95% and 42.82% specificity. CONCLUSIONS: Both PLR and NLR could be considered acceptable markers of erythropoietin resistance. The PLR was a better predictor for the ERI than the NLR
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Erythropoietin/blood , Erythropoietin/pharmacology , Kidney Failure, Chronic/blood , Lymphocyte Count , Neutrophils , Platelet Count , Renal Dialysis , Anemia/blood , Anemia/drug therapy , Anemia/etiology , Area Under Curve , Biomarkers , C-Reactive Protein/analysis , Cross-Sectional Studies , Drug Resistance , Erythropoietin/therapeutic use , Hemoglobins/analysis , Iron/blood , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , ROC Curve , Recombinant Proteins/pharmacology , Recombinant Proteins/therapeutic use , Regression AnalysisSubject(s)
Kidney Failure, Chronic/therapy , Renal Dialysis/standards , Age Factors , Aged, 80 and over , Fatal Outcome , Humans , MaleABSTRACT
INTRODUCTION: The platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte (NLR) ratios are emerging markers of inflammation. Erythropoietin resistance is associated with increased morbidity and mortality in patients with chronic kidney disease and is influenced by inflammation, among other factors. Therefore, it would be reasonable to expect a relationship between these markers and erythropoietin resistance. METHODS: Multicentre cross-sectional study. The records of the haemodialysis sessions of 534 patients belonging to four of our dialysis centres were studied. 137 patients were excluded, so the final number of patients studied was 397. NLR, PLR and the erythropoietin resistance index (ERI) were calculated. RESULTS: The ERI was divided into quartiles and compared with the mean NLR and PLR of the four groups, with these differences being statistically significant (p=0.00058). In the regression analysis, the NLR value was able to predict ERI significantly (p<0.0001) (R2=0.029). The PLR value also predicted ERI significantly (p<0.0001) (R2=0.103). The ability of PLR to predict erythropoietin resistance was measured with the area under the ROC curve (AUC=0.681) (95% CI, 0.541-0.821). A PLR cut-off point of 125.5 would result in a sensitivity of 80.95% and 42.82% specificity. CONCLUSIONS: Both PLR and NLR could be considered acceptable markers of erythropoietin resistance. The PLR was a better predictor for the ERI than the NLR.
Subject(s)
Erythropoietin/blood , Erythropoietin/pharmacology , Kidney Failure, Chronic/blood , Lymphocyte Count , Neutrophils , Platelet Count , Renal Dialysis , Aged , Anemia/blood , Anemia/drug therapy , Anemia/etiology , Area Under Curve , Biomarkers , C-Reactive Protein/analysis , Cross-Sectional Studies , Drug Resistance , Erythropoietin/therapeutic use , Female , Hemoglobins/analysis , Humans , Iron/blood , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Male , Middle Aged , ROC Curve , Recombinant Proteins/pharmacology , Recombinant Proteins/therapeutic use , Regression AnalysisABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Aged , Renal Dialysis/methods , Coronavirus Infections/prevention & control , Pneumonia, Viral/prevention & control , Pandemics/prevention & control , Containment of Biohazards/standards , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Betacoronavirus , Enzyme-Linked Immunosorbent Assay/methods , Kidney Diseases/etiologyABSTRACT
No disponible
Subject(s)
Humans , Blood Platelets , Kidney Diseases/blood , Lymphocytes , Neutrophils , Kidney Diseases/physiopathology , Platelet Count , Leukocyte CountABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Hemodiafiltration/methods , Porphyria Cutanea Tarda/therapy , Renal Dialysis/methods , Chloroquine/administration & dosage , Protoporphyrins/analysis , BiopsySubject(s)
Blood Platelets , Kidney Diseases/blood , Lymphocytes , Neutrophils , Humans , Kidney Diseases/physiopathology , Leukocyte Count , Platelet CountSubject(s)
Hemodiafiltration/methods , Porphyria Cutanea Tarda/therapy , Chloroquine/therapeutic use , Dermatologic Agents/therapeutic use , Diabetic Nephropathies/therapy , Disease Progression , Humans , Life Style , Male , Middle Aged , Porphyria Cutanea Tarda/pathology , Renal Dialysis , Symptom Flare UpABSTRACT
OBJECTIVE: To study whether the score proposed by the International Society of Renal Nutrition and Metabolism to define the protein energy wasting (PEW) syndrome has diagnostic validity in patients undergoing dialysis. DESIGN AND METHODS: Cross-sectional study including 468 prevalent hemodialysis patients from Canary Islands, Spain. Individual PEW syndrome criteria and the number of PEW syndrome categories were related to other objective markers of PEW using linear and logistic regression analyses: subjective global assessment, handgrip strength, bioimpedance-assessed body composition, and levels of high-sensitivity C-reactive protein. RESULTS: Study participants (34% women) had a median age of 66 years, 37 months of maintenance dialysis, and 50% were diabetics. About 23% of patients had PEW (≥3 PEW categories), and 68% were at risk of PEW (1-2 PEW categories). Low prealbumin was the most frequently found derangement (52% of cases), followed by low albumin (46%), and low protein intake (35%). Across higher number of PEW syndrome categories, patients showed a longer dialysis vintage and had lower creatinine, triglycerides, and transferrin (P for trend <.001 for all). All nutritional assessments not included in the PEW definition worsened across higher number of PEW categories. In multivariable regression analyses, there was a linear inverse relationship between muscle and fat mass as well as handgrip strength with the number of PEW syndrome categories. Likewise, the proportion of subjective global assessment-defined malnutrition and serum concentration of C-reactive protein gradually increased despite adjustment for confounders (P for trend <.05 for all). CONCLUSION: The PEW score reflects systemic inflammation, malnutrition and wasting among dialysis patients and may thus be used for diagnostic purposes.
Subject(s)
Protein-Energy Malnutrition/complications , Protein-Energy Malnutrition/diagnosis , Protein-Energy Malnutrition/physiopathology , Renal Dialysis , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Aged , C-Reactive Protein , Cross-Sectional Studies , Electric Impedance , Female , Hand Strength/physiology , Humans , Male , Middle Aged , Prevalence , SpainABSTRACT
Although clinical presentation of fibrillary glomerulonephritis is similar to most forms of glomerulonephritis, it is usually difficult to make the diagnosis. Clinical manifestations include proteinuria, microscopic haematuria, nephrotic syndrome, and impairment of renal function. A diagnosis of fibrillary glomerulonephritis is only confirmed by renal biopsy and it must comprise electronmicroscopy-verified ultrastructural findings. We report four cases between 45-50 years old with documented type 2 diabetes mellitus (T2DM) and arterial hypertension. All patients were found to have fibrils on kidney biopsy. The differential diagnosis of fibrils in the setting of diabetes mellitus is also discussed.
ABSTRACT
La insuficiencia cardíaca (IC) y el fracaso renal agudo (FRA) son dos entidades muy prevalentes en nuestro medio, e inciden de manera directa y sinérgicamente en la morbimortalidad de nuestros pacientes. Cuando es oligoanúrico, el FRA suele conducir a la sobrecarga hídrica, representando esta el núcleo precipitante del mecanismo de descompensación aguda de la IC, y está asociada con el agravamiento de los síntomas, la hospitalización y la muerte. Determinar el balance hídrico en la IC puede ser complejo y depende, en gran medida, de la fisiopatología subyacente. Los nuevos biomarcadores y las nuevas tecnologías están demostrando ser útiles para la detección e identificación de riesgo de IC descompensada aguda que puede permitir una pronta intervención y reversión del FRA que se traduzca en mejores resultados clínicos (AU)
Heart failure (HF) and acute renal failure (ARF) are two very prevalent entities in our environment which impact directly and synergistically in the morbidity and mortality of our patients. ARF, when oligoanuric, often leads to water overload. It represents the precipitating core of the mechanism of acute decompensation of the HF and is associated with the worsening of symptoms, hospitalisation and death. Determining the water balance in HF can be complex and depends, largely, on the underlying pathophysiology. New biomarkers and new technologies are proving to be useful for the detection and identification of risk of acutely decompensated HF that may allow early intervention and reversal of the ARF that translates into better clinical outcomes (AU)
Subject(s)
Humans , Heart Failure/physiopathology , Acute Kidney Injury/physiopathology , Water-Electrolyte Imbalance/etiology , Biomarkers/analysis , Risk FactorsABSTRACT
Heart failure (HF) and acute renal failure (ARF) are two very prevalent entities in our environment which impact directly and synergistically in the morbidity and mortality of our patients. ARF, when oligoanuric, often leads to water overload. It represents the precipitating core of the mechanism of acute decompensation of the HF and is associated with the worsening of symptoms, hospitalisation and death. Determining the water balance in HF can be complex and depends, largely, on the underlying pathophysiology. New biomarkers and new technologies are proving to be useful for the detection and identification of risk of acutely decompensated HF that may allow early intervention and reversal of the ARF that translates into better clinical outcomes.
Subject(s)
Acute Kidney Injury/diagnosis , Acute Kidney Injury/metabolism , Heart Failure/diagnosis , Heart Failure/metabolism , Water/metabolism , Biomarkers , HumansABSTRACT
El 4-10% de los pacientes incidentes en diálisis portan un injerto renal no funcionante y hasta en el 32% de los casos, según las series, se requiere la realización de trasplantectomía por diversas causas. La mortalidad de estos pacientes es significativamente mayor que la de aquéllos con injerto funcionante o en terapia renal sustitutiva sin injerto previo. Se han sugerido como indicaciones actuales de trasplantectomía el síndrome de intolerancia al injerto, la pérdida precoz de éste, la presencia de proteinuria grave, pielonefritis recurrentes o neoplasia y el síndrome de inflamación crónica. El síndrome de inflamación crónica se presenta en enfermos con elevación de los marcadores de inflamación (proteína C reactiva), anemia con resistencia al tratamiento con estimuladores de la eritropoyesis y marcadores de desnutrición en su contexto. Esta situación de inflamación está provocada por el injerto y revierte tras la trasplantectomía, como han demostrado varios estudios. Hemos revisado la literatura publicada al respecto, las indicaciones de trasplantectomía, o embolectomía, sus ventajas e inconvenientes; la incidencia del síndrome de intolerancia al injerto y la fisiopatología del síndrome de inflamación crónica, así como el algoritmo de manejo terapéutico propuesto actualmente (AU)
Approximately 4%-10% of incident patients on dialysis have a non-functioning kidney graft, and according to series, as many as 32% require transplantectomy for a variety of reasons. Mortality in these patients is significantly higher than in those with a functioning graft or on renal replacement therapy without having received a graft. Graft intolerance syndrome, early graft loss, severe proteinuria, recurring pyelonephritis or neoplasia, and chronic inflammation syndrome have all been proposed as indications for transplantectomy. Chronic inflammation syndrome occurs in patients with high levels of inflammatory markers (C-reactive protein), anaemia resistant to treatment with erythropoiesis stimulators, and malnutrition markers. This inflammatory state is provoked by the graft, and reverts when a transplantectomy is performed, as several studies have shown. We have reviewed the medical literature published on this topic, the indications for transplantectomy and embolectomy, their advantages and disadvantages, the incidence of graft intolerance syndrome, and the pathophysiology of chronic inflammation syndrome, as well as the currently proposed therapeutic management algorithm (AU)
Subject(s)
Humans , Nephrectomy , Kidney Transplantation/adverse effects , Graft Rejection/surgery , Embolization, Therapeutic , Systemic Inflammatory Response Syndrome/complicationsABSTRACT
Approximately 4%-10% of incident patients on dialysis have a non-functioning kidney graft, and according to series, as many as 32% require transplantectomy for a variety of reasons. Mortality in these patients is significantly higher than in those with a functioning graft or on renal replacement therapy without having received a graft. Graft intolerance syndrome, early graft loss, severe proteinuria, recurring pyelonephritis or neoplasia, and chronic inflammation syndrome have all been proposed as indications for transplantectomy. Chronic inflammation syndrome occurs in patients with high levels of inflammatory markers (C-reactive protein), anaemia resistant to treatment with erythropoiesis stimulators, and malnutrition markers. This inflammatory state is provoked by the graft, and reverts when a transplantectomy is performed, as several studies have shown. We have reviewed the medical literature published on this topic, the indications for transplantectomy and embolectomy, their advantages and disadvantages, the incidence of graft intolerance syndrome, and the pathophysiology of chronic inflammation syndrome, as well as the currently proposed therapeutic management algorithm.