Empleo de alimentos funcionales y probióticos en la prevenciónde enfermedades infecciosas y alérgicas / No disponible

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Untoward effects of chronic dual renin-angiotensin system blockade: influence of previous chronic renal failure.

Dual blockade of the renin-angiotensin system (RAS) has increased antiproteinuric effects and so a higher incidence of secondary effects can be expected when this kind of treatment is administered. The aim of this study was to assess the safety of dual blockade of RAS. Seventy-five (54 men and 21 women) patients has been treated in our unit with dual RAS blockade due to proteinuria higher than 1 g/24 h. Mean age was 57.1 +/- 14.0 years. Fifty-three patients had chronic renal failure (CRF) at baseline. Analytical data of 6 months visit and last follow-up visit were recorded. A small reduction of systolic blood pressure and diastolic blood pressure was observed in both treatment groups throughout the study. Neither the CRF patients nor those with normal renal function showed any reduction in mean plasma haemoglobin levels, but differences between groups were significant at the second and third visits (anova). No change was detected in haematocrit. Mean K+ significantly increase at the second visit in the CRF group (from 4.80 +/- 0.64 to 5.23 +/- 0.81 mmol/l, p < 0.001, Student's t-test). There were no changes in normal kidney function group (4.58 +/- 0.37 vs. 4.63 +/- 0.44). At baseline plasmatic creatinine was higher in the CRF group (2.09 +/- 0.60 0.20 mg/dl vs. 0.99 +/- 0.20 mg/dl, p < 0.001, Student's t-test) and creatinine clearance was lower (48.6 +/- 20.7 ml/min vs. 107.0 +/- 0.30 ml/min, p < 0.001, Student's t-test). There was a small increase in creatinine along the follow-up when compared with the normal renal function group (p < 0.001, anova). Conversely, creatinine clearance remain unchanged in the normal renal function group, and there was a decrease in creatinine in CRF patients (p < 0.001). Dual RAS blockade seems to be safe in renal patients even when mild to moderate renal failure is present. Severe hyperkalaemia is uncommon. Small increments in plasmatic creatinine can be seen but they are hardly dangerous. Combined treatment does not significantly influence erythropoiesis.

Niveles de ácido úrico y proteína C reactiva en pacientes con insuficiencia renal crónica / Serum uric acid and c-reactive protein levels in patients with chronic kidney disease

Tanto la inflamación como la hiperuricemia se relacionan con un aumento delriesgo cardiovascular y mortalidad en general. Una hipotética relación entre inflamacióne hiperuricemia no ha sido nunca analizada en pacientes con insuficienciarenal crónica (IRC). El objetivo de este estudio fue determinar la prevalenciade un incremento de los niveles de Proteína C Reactiva (PCR), y valorar la hipótesisde una relación entre los niveles de ácido úrico (AU) y PCR.Se estudiaron 337 pacientes (174 hombres, edad media 63 ± 16 años), conIRC prediálisis. Los niveles de PCR de alta sensibilidad fueron analizados comouna variable cualitativa o como una variable continua transformada en logaritmo(log-PCR). Las variables independientes incluidas en los análisis de regresión logísticay lineal fueron: demográficas, características clínicas y bioquímicas, incluyendolos niveles de AU. En un subgrupo de 169 pacientes sin diabetes se realizóel mismo estudio, incluyendo además como variables los niveles basales deinsulina y el parámetro de resistencia a la insulina HOMA-IR.La mediana de PCR fue 3,25 mg/L, y la media de AU de 7,59 ± 1,94 mg/dl.Los pacientes con PCR superior a la mediana tenían una concentración media deAU significativamente mayor a la del resto de los pacientes (7,93 ± 1,79 vs 7,24± 2,03 mg/dl, p = 0,001). Hubo una correlación significativa entre los niveles deAU y log-PCR (r = 0,16, p = 0,0022). La relación entre PCR y AU continuó siendoestadísticamente significativa tras ajuste con la edad, sexo, comorbilidad, obesidad,función renal residual, tratamiento con diuréticos o alopurinol (OR: 1,296,p = 0,0003; y beta: 0,204, p = 0,0002). La asociación significativa entre PCR yAU no cambió cuando se añadieron al modelo el HOMA-IR o los niveles de insulinabasal en el subgrupo de 169 pacientes no diabéticos.En conclusión, los niveles de AU se relacionan de forma independiente con losde PCR en pacientes con IRC

Either inflammation or hyperuricemia has been related with increased cardiovascularrisk and mortality. A hypothetical relationship between serum uric acid levels (SUA) and inflammatory markers has never been tested in chronic kidneydisease (CKD) patients. The purpose of this study was to determine the prevalenceof increased C-reactive protein (CRP) levels in CKD patients, and to test thehypothesis of a relationship between SUA and CRP levels.The study group consisted of 337 patients (174 males, mean age 63 ± 16 years)with advanced chronic renal failure not yet on dialysis. None of them had overtinflammatory or infectious diseases. High sensitivity CRP levels were analyzed asa binary (above or below median value), or continuous variable (log-transformedCRP), by multiple logistic or linear regression analysis, respectively. Demographics,clinical, and biochemical characteristics, including SUA levels, were the variablestested in these analysis. In a subset of 169 patients without diabetes, the sameanalysis were carried out, with the inclusion of fasting insulin levels and HOMAIRas independent variables.Median CRP level was 3.25 mg/L, and mean SUA level was 7.59 ± 1.94 mg/dl.Patients with CRP levels above the median had significantly higher mean SUA levelthan that of the rest of study patients (7.93 ± 1.79 vs 7.24 ± 2.03 mg/dl, p =0.001). SUA levels correlated significantly with log-transformed CRP levels (r =0.16, p = 0.0022). The relationship between SUA and CRP levels remained statisticallysignificant after adjustment for age, sex, comorbid index, obesity, residualrenal function, diuretic and allopurinol treatment, in the multivariate logistic andlinear regression models (OR: 1.296, p = 0.0003; and beta: 0.204, p = 0.0002).The significant association between SUA and CRP levels did not change whenHOMA-IR and fasting insulin levels were included as independent variables in thesubset of 169 patients without diabetes.In conclusion, SUA levels are related with CRP levels in CKD patients

[Serum uric acid and C-reactive protein levels in patients with chronic kidney disease]. / Niveles de ácido úrico y proteína C reactiva en pacientes con insuficiencia renal crónica.

Either inflammation or hyperuricemia has been related with increased cardiovascular risk and mortality. A hypothetical relationship between serum uric acid levels (SUA) and inflammatory markers has never been tested in chronic kidney disease (CKD) patients. The purpose of this study was to determine the prevalence of increased C-reactive protein (CRP) levels in CKD patients, and to test the hypothesis of a relationship between SUA and CRP levels. The study group consisted of 337 patients (174 males, mean age 63 +/- 16 years) with advanced chronic renal failure not yet on dialysis. None of them had overt inflammatory or infectious diseases. High sensitivity CRP levels were analyzed as a binary (above or below median value), or continuous variable (log-transformed CRP), by multiple logistic or linear regression analysis, respectively. Demographics, clinical, and biochemical characteristics, including SUA levels, were the variables tested in these analysis. In a subset of 169 patients without diabetes, the same analysis were carried out, with the inclusion of fasting insulin levels and HOMA-IR as independent variables. Median CRP level was 3.25 mg/L, and mean SUA level was 7.59 +/- 1.94 mg/dl. Patients with CRP levels above the median had significantly higher mean SUA level than that of the rest of study patients (7.93 +/- 1.79 vs 7.24 +/- 2.03 mg/dl, p = 0.001). SUA levels correlated significantly with log-transformed CRP levels (r = 0. 16, p = 0.0022). The relationship between SUA and CRP levels remained statistically significant after adjustment for age, sex, comorbid index, obesity, residual renal function, diuretic and allopurinol treatment, in the multivariate logistic and linear regression models (OR: 1.296, p = 0.0003; and beta: 0.204, p = 0.0002). The significant association between SUA and CRP levels did not change when HOMA-IR and fasting insulin levels were included as independent variables in the subset of 169 patients without diabetes. In conclusion, SUA levels are related with CRP levels in CKD patients.

Informe de diálisis y trasplante de la Sociedad Española de Nefrología y Registros Autonómicos, año 2000 / Rapport of the dialysis and transplant registry in Spain. The Spanish Society of Nephrology and Regional Registries

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Hipertensión de bata blanca / White coar hypertension

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Resultados a largo plazo de un régimen de descolonización de Staphylococcus aureus en pacientes en diálisis peritoneal / Catheter exit site infection (ESI) remains a common complication in peritoneal dialysis patients. All the efforts for controlling ESI have been focused on the preventive

La infección del orificio de salida del catéter peritoneal y/o túnel subcutáneo(ISC) sigue siendo una complicación frecuente de la diálisis peritoneal (DP). Las principales medidas para el control de las ISC se han centrado en la erradicación de la colonización del Staphylococcus aureus (SA), microorganismo que está imicado en la mayoría de estas infecciones. El objetivo del presente estudio fue analizar los resultados a largo plazo de un régimen de descolonización del SA y su potencial impacto sobre la incidencia total de ISC. Sesenta pacientes que iniciaron DP entre enero 1993 y diciembre 1999 fueron incluidos en el protocolo de descolonización de SA. Cada 30-45 días se toma en muestras para cultivo de la nariz y salida del catéter. La colonización por SA en cada una de estas regiones fue tratada con mupirocina. La colonización por otros microorganismos no fue tratada. Treinta pacientes en DP seguidos en la misma unidad durante los años 1989-1992 sirvieron de grupo control. Los datos epidemiológicos de los cultivos, así como la tasa de peritonitis e ISC fueron (..) (AU)

Long term results of a descolonization regimen of staphylococcus aureus in peritoneal dialysis patients eradication of Staphylococcus aureus (SA) colonization, because this microorganisms has been shown to be implicated in most of ESI. The main aims of the present study was to analyse the long-term results from an eradicative regimen of SA colonization, and to compare them with those obtained from a historical control group. From january 1993 to december 1999, 60 unselected patients on PD underwent an exhustive protocol of SA eradication. Every 30-45 days, cultures from nares and exit site were obtained in each patient. SA colonization in nares or exit site was treated with mupirocin, though the colonization of other microorganisms was not treated prophylactically. Thirthy patients from the same unit who were (..) (AU)

[Ambulatory blood pressure monitoring in young patients]. / Monitorización ambulatoria de presión arterial (MAPA) en enfermos jóvenes.

OBJECTIVE: To defining the criteria for performing ambulatory blood pressure monitoring (ABPM) in young patients. METHOD: It is reported the experience with ABPM on 52 consecutive patients (younger than 30 years old) consulting for hypertension (mean age 23.4 +/- 4.9 years). The ambulatory BP was measured noninvasively for twenty-seven hours by the Spacelabs 90207 device programmed to measure BP every fifteen minutes during daytime and every 20 minutes during nighttime. The definition of daytime and nighttime was made on the basis of wakefulness and sleep or bed rest periods, obtained from a diary kept by the subject, normal nocturnal BP drop was defined as a decrease higher of 10% versus daytime values. It was defined normal BP an 24 hours ambulatory BP < 130/80 mmHg. RESULTS: Thirty seven patients (71%) were normotensives. There were not differences between normotensive and hypertensive patients neither by age (normotensive 23.9 +/- 12.5, hypertensive 23.3 +/- 4.0 years), nor by sex (normotensive, 21 men and 16 women; hypertensive, 10 men and 3 women). Mean 24 h BP of normotensive patients was 119/72 mmHg (p < 0.001 vs. hypertensive, 135/89 mmHg). There were not differences in nocturnal BP drop. White-coat reaction was more intense in normotensive patients (1.17 +/- 0.12, vs. hypertensive 1.04 +/- 0.08, p < 0.001). Four hypertensives showed white-coat reaction (1.11 +/- 0.05). CONCLUSION: ABPM is a helpful diagnostic tool in young patients. It should be routinely performed as first exploration in all patients younger than 30 years consulting for hypertension.

[Predictors of early death during dialysis]. / Predictores de la mortalidad precoz en diálisis.

The mortality among end-stage renal failure (ESRF) patients undergoing renal replacement therapy (RRT) remains high. An important proportion of these patients die shortly after the initiation of RRT. The present study aims to determine the best predictors for the early mortality in a group of 140 ESRF patients who initiated RRT between october 96 and december 99. The mean age of the study group was 61 +/- 13 years, and the mean follow-up time was 20 +/- 12 months. Diabetic nephropathy was the most prevalent etiology of renal failure (30%). The following data, collected immediately before the initiation of RRT, were included as independent variables: demographic and clinical characteristics, including the nutritional status established by the Subjective Global Assessment (SGA), follow-up time in the predialysis clinic (less or longer than 3 months), EPO therapy, vascular access, renal function (creatinine and urea clearances, and Kt/V urea), hematological and biochemical data including serum albumin, bicarbonate, transferrin, PTH and C-Reactive protein, as well as the protein catabolic rate and the percent of lean body mass normalized for ideal body weight, calculated from the 24 h total urine excretion of nitrogen and creatinine. The Cox proportional hazard regression model, stratified for an age over or less than 65 year, was utilized to determine the best predictors for the mortality during the study period. Sixty percent of patients had at least one comorbid condition, and 35% had cardiovascular diseases. Mild-moderate or severe malnutrition was observed in 48% of patients. The creatinine clearance and Kt/V urea before the initiation of RRT were: 9.50 +/- 2.64 ml/min/1.73 m2 and 1.47 +/- 0.44, respectively. Forty-one patients died during the study period (annual death rate: 17%). The best predictor of mortality was the nutritional status assessed by the SGA (OR: 2.32, IC 95% 1.54-3.48, p < 0.0001). In a second analysis in which the SGA was removed from the model, the previous history of cardiovascular diseases (OR: 2.07, CI 95%: 1.06-4.06, p = 0.032), and the percent of lean body mass/ideal weight (OR: 0.96; IC 95%: 0.93-0.99; p = 0.042), proved to be the best predictor of mortality. In conclusion, nutritional indices prior to the initiation of RRT, and the previous history of cardiovascular diseases were the best predictors of the early mortality in this unselected population on dialysis. Because nutritional status appeared to be a marker of the severity of the comorbid conditions, a better control of the number and severity of these comorbid conditions may be the best way for reducing the mortality in patients on RRT.

Acute effect of hemodialysis with polyacrylonitrile membrane on nerve conduction velocities.

AIM: Non cellulosic membranes, as polyacrylonitrile (AN69) improves middle-molecules purification through hemodialysis, and this increased clearance of middle-molecules may have benefical effects on uremic polyneuropathy. We have tried to evaluate this effect comparing nerve conduction velocities before and after hemodialysis with either AN69 or cellulose acetate (CA). PATIENTS AND METHODS: Eight patients in hemodialysis with AN69 for more than three months (4 men and 4 women, mean age 58.4 +/- 12.9 years, mean time in hemodialysis 9.3 +/- 7.5 months). Motor conduction velocities (MCV) and sensory conduction velocities (SCV) were measured predialysis and postdialysis with AN69 and, one week later, predialysis and postdialysis with CA. RESULTS: There were no differences neither in Kt/V values (AN69 1.27 +/- 0.36 vs CA 1.16 +/- 0.26) nor in TAC ones (AN69 40.8 +/- 17.4 vs CA 40.8 +/- 21.3 mg/dL). After hemodialysis with AN69 MCV significantly increased (42.0 +/- 3.0 vs 40.6 +/- 2.6 m/s baseline, p < 0.05). SCV was also enhanced (45.3 +/- 2.2 vs 41.1 +/- 3.4 m/s baseline, p < 0.05). After hemodialysis with CA neither MCV changed (42.7 +/- 1.6 vs 42.0 +/- 2.3 m/s baseline), nor did SCV (45.8 +/- 5.8 vs 44.8 +/- 3.0 m/s baseline). CONCLUSIONS: Hemodialysis with AN69 acutely improved SCV and MCV. This effect was not seen with CA hemodialysis.

Monitorización ambulatoria de presión arterial (MAPA) en enfermos jóvenes / Ambulatory blood pressure monitoring (ABPM) in young patients

Objetivo: Aunque se han definido diversas indicaciones genéricas para el uso de la MAPA, sus indicaciones específicas en grupos de población especiales no han sido completamente definidos. Este es el caso de su utilidad en el diagnóstico en pacientes jóvenes, es decir, aquellos que tiene menos de 30 años. Métodos: Se ha realizado MAPA en 52 casos consecutivos de HTA en pacientes menores de 30 años (edad media 23,4 ± 4,9, entre 12 y 30 años). El estudio se realizó en todos los casos sin tratamiento (si fue preciso suspenderlo, esta suspensión se realizó al menos 10 diez días antes) según los criterios habituales (colocación en brazo no dominante, definición de periodo diurno y nocturno personalizada, mediciones cada 15 min. en el periodo diurno y cada 20 min. en el nocturno). Se definió normotensión como un promedio de PA inferior a 130/80 mmHg en 24h. La reacción de bata blanca (RBB) se calcula como 1ª medición / media periodo diurno. Se consideró la presencia de RBB como un valor superior a 1,1. Para valorar la normalidad del descenso nocturno se consideró una reducción mínima del 10 por ciento respecto a los valores diurnos. Resultados: En 37 (71 por ciento) casos se comprobó que el paciente presentaba normotensión en la MAPA. No hubo diferencias en la edad entre normotensos (23,9 ± 5,1) e hipertensos (23,2 ± 4,0 años) ni en el sexo (normotensos 21 varones y 16 mujeres, hipertensos 10 varones y 3 mujeres). La PA media de los normotensos fue 119/72 (p<0,001 frente a hipertensos, 135/89 mmHg). No hubo diferencias en el descenso nocturno entre ambos grupos. La RBB fue más intensa en el grupo de normotensos (1,17 ± 0,12) frente a hipertensos (1,04 ± 0,08, p<0,001), aunque 4 hipertensos presentaban RBB (1,11 ± 0,05). Conclusiones: La realización de MAPA para aconsejable para confirmar el diagnóstico de HTA en los pacientes menores de 30 años antes de realizar otras técnicas diagnósticas (AU)

[Usefulness of ambulatory blood pressure monitoring in kidney disease]. / Utilidad de la monitorización ambulatoria de presión arterial (MAPA) en enfermos renales.

High blood pressure is both a cause and a manifestation of renal disease. It has an increasing prevalence among renal patients renal function is declining. Blood pressure is not a constant value, but it shows a high intrinsic and extrinsic variability. It is common to find striking discordances between blood pressure values and target organ damage. The average values obtained through ambulatory blood pressure monitoring (ABPM) are better related with cardiovascular morbility and mortality than office measurement, even in renal disease patients. We report the experience with ABPM on 51 renal patients. None of them was on renal replacement therapy. In 7 out of 14 non treated patients ABPM showed clinic hypertension only. Mean age of truly hypertensive patients was higher, but this difference was not significant (normotensive 31.7 +/- 17.1; hypertensive 49.4 +/- 17.9 years, p < 0.1). There were no sex differences (normotensive, 5 males and 2 females; hypertensive, 4 males and 3 females). Three normotensive patients had chronic renal failure, and as did 6 hypertensive patients (p < 0.1). There were no differences in night-time drop either for systolic (normotensive 3.7 +/- 3.5 hypertensive 6.1 +/- 8.9%) or for diastolic blood pressure (normotensive 10.4 +/- 4.7 hypertensive 6.2 +/- 8.9%). Thirty-seven patients who were on antihypertensive drug treatment: 23 (68.2%) showed hypertension after the ABPM and 14 (37.8%) have normal blood pressure values, more over, 4 of these 14 patients showed hypotension. There were neither age differences between the groups (normotensive 49.0 +/- 12.5, hypertensive 51.9 +/- 15.4 years), nor sex differences (normotensive 9 males and 5 females, hypertensive 11 males and 12 females). The prevalence of renal failure was similar (normotensive, 85.7%; hypertensive, 82.6%). Mean night-time drop was not different (SBP, normotensive 6.1 +/- 7.6 hypertensive 7.2 +/- 7.6%; DBP, normotensive 9.0 +/- 8.3 hypertensive 13.5 +/- 7.6%). ABPM is a helpful diagnostic tool in renal disease as in the non complicated essential hypertension patient, both for experimental and for clinical purposes.

Predictores de la mortalidad precoz en diálisis / Predictors of early mortality in dialysis patients

La mortalidad entre los pacientes sometidos a diálisis sigue siendo elevada. Una importante proporción de estos pacientes fallece pocos meses después del inicio del tratamiento. Con el objetivo de establecer cuáles son los principales determinantes de la mortalidad precoz en diálisis se realizó este estudio en 140 pacientes que comenzaron diálisis de forma no urgente. La edad fue de 61 ñ 13 años y el tiempo medio de seguimiento de 20 ñ 12 meses. La nefropatía diabética fue la etiología más prevalente de insuficiencia renal (30 por ciento). Antes del inicio de la diálisis se recogieron los siguientes datos: características demográficas y clínicas, entre las que se incluyó el estado de nutrición determinado por la Estimación Subjetiva Global (ESG), tiempo de seguimiento en la consulta prediálisis (superior o inferior a 3 meses), tratamiento con eritropoyetina, acceso vascular funcionante, función renal (aclaramiento de creatinina, aclaramiento de urea y Kt/V urea), datos hematológicos y bioquímicos, incluyendo albúmina, bicarbonato, transferrina, PTH, proteína C reactiva, además del cálculo de la tasa de catabolismo protéico y del procentaje de masa magra, normalizados ambos al peso ideal. Mediante la regresión de riesgo proporcinal de Cox con ajuste a la edad (superior o inferior a 65 años), se determinó en análisis multivariable cuál fue el mejor predictor de la mortalidad durante el período de seguimiento.El 60 por ciento de los pacientes presentaba algún proceso comórbido asociado, y el 35 por ciento padecía enfermedad cardiovascular. El 48 por ciento de los pacientes tenían algún grado de desnutrición según la ESG. El aclaramiento medio de creatinina corregido a 1.73 m2 y el Kt/V urea fueron 9,50 ñ 2,64 ml/min y 1,47 ñ 0,44 respectivamente. Durante el período de seguimiento fallecieron 41 pacientes (29 por ciento) (mortalidad anual del 17 por ciento). El mejor determinante de la mortalidad ajustado a la edad fue el estado de nutrición según la ESG (odds ratio: 2,32, IC 95 por ciento 1,54-3,48, p < 0,001). En un segundo análisis en el que no se incluyó la ESG, la historia previa de enfermedad cardiovascular (odds ratio: 2,07, IC 95 por ciento: 1,06-4,06, p = 0,032), y el porcentaje de masa magra/peso ideal (odds ratio: 0,96; IC 95 por ciento: 0,93-0,99; p = 0,042) fueron los mejores determinantes de la mortalidad.En conclusión, marcadores del estado de nutrición tales como la ESG y la masa magra normalizada al peso ideal, junto con la historia previa de enfermedad vas- cular fueron los principales predictores de la mortalidad precoz en pacientes que iniciaron un tratamiento de diálisis. Un mejor control del número y severidad de los procesos comórbidos podría reducir la mortalidad en los pacientes con insuficiencia renal terminal. (AU)

Determination of the odor threshold concentrations of iodinated trihalomethanes in drinking water.

Iodinated trihalomethanes (ITHMs) have been usually considered the disinfection byproducts suspected of causing medicinal odor episodes in treated water around the world. The odor threshold concentration (OTC) of mixed ITHMs (bromochloroiodo-, bromodiiodo-, chlorodiiodo-, dibromoiodo-, and dichloroiodomethane) which were previously synthesized -- because commercial standards are not available-- were determined by using two sensory techniques: flavor profile analysis (FPA), performed by an experienced panel trained in identifying odors and tastes in water; and gas chromatography coupled with olfactometry (GCO). FPA results gave a theoretical OTCs range from 0.1 to 8.9 microg/L and ITHMs were described as sweet, solvent, and medicinal products. The lowest experimental value (OTC(exp)) obtained from the six ITHMs, 0.03 microg/L, corresponded to iodoform.

Utilidad de la monitorización ambulatoria de presión arterial (MAPA) en enfermos renales / Ambulatory blood pressure monitoring (ABPM) in renal patients

En la clínica es posible encontrar discordancias importantes entre cifras de PA y la lesión de órganos diana. Los valores promedios obtenidos mediante MAPA se correlacionan mejor con el daño de órganos diana que las tomas causales, incluso en pacientes con enfermedad renal. El objetivo de este estudio ha sido valorar la utilidad clínica de la MAPA en el manejo diagnóstico y terapéutico de la hipertensión arterial en enfermos renales.Se recoge la experiencia, en 51 registros realizados en pacientes con insuficiencia renal. En 7 de 14 pacientes sin tratamiento se demostró hipertensión clínica aislada (HCA). La edad media de los hipertensos era superior, pero no llegaba a ser significativa (HCA 31,7 ñ 17,1; hipertensos 49,4 ñ 17,9 años, p < 0,1). Tampoco había diferencias por sexo (HCA, 5 hombres y 2 mujeres; hipertensos, 4 hombres y 3 mujeres). En el grupo de pacientes con HCA en el MAPA había sólo tres que presentaban azotemia, frente a 6 en el grupo de hipertensos (p < 0,1). No se detectaron diferencias en el descenso nocturno de la PA entre los dos grupos, ni en la PAS (HCA 3,7 ñ 3,5, hipertensos 6,1 ñ 8,9) ni en la PAD (HCA 10,4 ñ 4,7, hipertensos 6,2 ñ 8,9).De 37 pacientes que recibían tratamiento hipotensor, 23 de ellos (68,2 por ciento) tenían cifras de PA superiores a las destacadas y 14 presentaban presiones normales con la mediación (37,8 por ciento). De estos 14, 4 presentaban cifras promedio de PA en el período diurno menores de 70 mmHg. No hubo diferencias en la edad media entre ambos grupos (controlados 49,0 ñ 12,5, no controlados 51,9 ñ 15,4 años), en el sexo (controlados 9 varones y 5 hembras, no controlados 11 varones y 12 hembras) ni en cuanto a la prevalencia de insuficiencia renal (controlados, 85,7 por ciento; no controlados, 82,6 por ciento).El descenso nocturno medio de la PAS no fue diferente entre ambos grupos (controlados 6,1 ñ 7,6, no controlados 7,2 ñ 7,6 por ciento). Tampoco hubo diferencias en la reducción de la PAD (controlados 9,0 ñ 8,3; no controlados 13,5 ñ 7,6 por ciento).Podemos concluir que el MAPA es útil en la insuficiencia renal en las mismas indicaciones que el hipertenso no complicado, tanto desde el punto de vista clínico como desde el experimental. (AU)

Acute effect of hemodialysis on sympathetic skin response.

Sympathetic skin response (SSR) is a useful and simple test for unmyelinated axon function in peripheral sensorimotor neuropathies. SSR was tested on a group of patients undergoing chronic regular hemodialysis before and after a single dialysis session. Nineteen patients in hemodialysis for more than three months were included. Nine patients were on dialysis with cellulosic membranes (CA, 3 male and 6 female, aged 57.7 +/- 16.4 years) and ten ones were on dialysis with non-cellulosic membranes (NC, 4 male and 6 female, aged 50.2 +/- 15.9 years) were studied. There were no differences neither in Kt/V values (NC 1.37 +/- 0.34 vs. CA 1.22 +/- 0.27) nor in TAC ones (NC 41.5 +/- 18.2 vs. CA 41.3 +/- 14.1 mg/dL). After hemodialysis with NC amplitude significantly increased (994 +/- 1015 vs. 382 +/- 465 microv baseline, p < 0.05). Latency did not change (1.76 +/- 0.83 vs. 2.07 +/- 0.50 s baseline). After hemodialysis with CA neither amplitude changed (1368 +/- 1074 vs. 1240 +/- 1594 microv baseline), nor did latency (1.79 +/- 0.35 vs. 1.94 +/- 0.59 s baseline). Hemodialysis with non-cellulosic membranes (but not with cellulose acetate) yields a short-term improvement of sympathetic skin response. This effect is similar to those seen in nerve conduction velocities and it may be related to increased middle-molecules depuration.

[Long-term results of an eradication regime against Staphylococcus aureus in patients treated with peritoneal dialysis]. / Resultados a largo plazo de un régimen de descolonización de Staphylococcus aureus en pacientes en diálisis peritoneal.

Catheter exit site infection (ESI) remains a common complication in peritoneal dialysis patients. All the efforts for controlling ESI have been focused on the preventive eradication of Staphylococcus aureus (SA) colonization, because this microorganisms has been shown to be implicated in most of ESI. The main aims of the present study was to analyse the long-term results from an eradicative regimen of SA colonization, and to compare them with those obtained from a historical control group. From january 1993 to december 1999, 60 unselected patients on PD underwent an exhaustive protocol of SA eradication. Every 30-45 days, cultures from nares and exit site were obtained in each patient. SA colonization in nares or exit site was treated with mupirocin, though the colonization of other microorganisms was not treated prophylactically. Thirty patients from the same unit who were followed between 1989-1992 served as historical control group. The rate of peritonitis and ESI, as well as the epidemiological data from the cultures were also analysed. The peritonitis and ESI rates were significantly less in the study group than those in the control group (0.398 +/- 0.553 vs 0.899 +/- 0.970 ep./pat/year, p = 0.002; and 0.102 +/- 0.235 vs 0.340 +/- 0.553 ep./pat/year, p = 0.004). The ESI rate caused by SA was also significantly less in the study group (0.018 +/- 0.096 vs 0.300 +/- 0.53 ep./pat/year, p = 0.0001), though there was a statistically nonsignificant increase in the ESI rate caused by gram negative microorganisms in the study group (0.066 +/- 0.194 vs 0.040 +/- 0.219 ep./pat./year). The percent of patients free of ESI was larger in the study group (80% vs 63%, p = 0.01), though the percent of patients with more than one ESI was the same in both groups (10%). Nasal and exit-site SA colonization occurred in 52% and 32% of the study patients. The rate of catheter loss was less in the study group, though it did not reach statistical significance (0.043 +/- 0.154 vs 0.178 +/- 0.443 losses/pat./year). In conclusion, the eradication of SA colonization is an efficacious measure for the control of ESI. However, further efforts should be carried out in order to control the emergence of gram negative microorganisms, and to discover which factors make a small proportion of PD patients to be more prone to develop ESI of whatever origin.

Simultaneous determination of cyanogen chloride and cyanogen bromide in treated water at sub-microg/L levels by a new solid-phase microextraction-gas chromatographic-electron-capture detection method.

A headspace solid-phase microextraction (HS-SPME) procedure has been developed and applied for the determination of cyanogen halides in treated water samples at microg/L concentrations. Several SPME coatings were tested, the divinylbenzene-Carboxen-polydimethylsiloxane fiber being the most appropriate coating. GC-electron-capture detection was used for separation and quantitation. Experimental parameters such as sample volume, addition of a salt, extraction time and desorption conditions were studied. The optimized method has an acceptable linearity, good precision, with RSD values <10% for both compounds, and it is sufficiently sensitive to detect ng/L levels. HS-SPME was compared with liquid-liquid microextraction (US Environmental Protection Agency Method 551.1) for the analysis of spiked ultrapure and granular activated carbon filtered water samples. There was good agreement between the results from both methods. Finally, the optimized procedure was applied to determine both compounds at the Barcelona water treatment plant (N.E. Spain). Cyanogen chloride in treated water was <1.0 microg/L and cyanogen bromide ranged from 3.2 to 6.4 microg/L.