Metabolic acidosis components in advanced chronic kidney disease: association with serum albumin and parathyroid hormone.

OBJECTIVE: To investigate the associations between the 2 main components of metabolic acidosis (unmeasured anions [UA] and hyperchloremia) with serum albumin and intact parathormone (iPTH) in patients with advanced chronic kidney disease. DESIGN AND METHODS: Cross-sectional study with advanced chronic kidney disease patients (estimated glomerular filtration rate <30 mL/minute/1.73 m(2)) not receiving phosphate binders, alkali therapy, or vitamin D analogs. Arterial blood sample was collected for biochemical and blood gas analysis. UA and strong ion difference (SID) were calculated according to quantitative acid-base analysis. Reduced SID was used as a measure of hyperchloremia. MAIN OUTCOME MEASURES: Serum albumin and parathormone (iPTH). RESULTS: A total of 383 patients were included with a mean age of 64.7 ± 16.3 year and a mean estimated glomerular filtration rate of 19.9 ± 12.1 mL/minute/1.73 m(2). Among patients with metabolic acidosis, 45.7% had metabolic acidosis exclusively because of UA and 53.7% had a hyperchloremic component (either mixed metabolic acidosis or pure hyperchloremic metabolic acidosis). Considering the main acid-base status determinants, only UA had a significant correlation with serum albumin (r = -0.278, P < .001). There was no correlation between serum albumin and SID (r = 0.083, P = .156). This is in opposition to serum iPTH, where there was no correlation with UA (r = 0.082, P = .114), but an inverse correlation between iPTH and SID was observed (r = -0.228, P < .001). Multiple linear regressions with all acid-base determinants confirmed these findings. CONCLUSIONS: Our data brings further knowledge on the associations between metabolic acidosis with bone disorders and nutritional status, suggesting that the two main metabolic acidosis components (UA and hyperchloremia) have different effects on serum parathormone and serum albumin.

Procedimentos Minimamente Invasivos ? Formas Direta e Videoassistida no Tratamento das Cardiopatias / Minimally Invasive Procedures - Direct and Video-Assisted Forms in the Treatment of Heart Diseases

Fundamento: Procedimentos cardiovasculares minimamente invasivos têm sido progressivamente empregados no tratamento das cardiopatias. Objetivo: Descrever as técnicas e os resultados imediatos dos procedimentos minimamente invasivos ao longo de uma experiência de 5 anos. Métodos: Estudo unicêntrico, descritivo e prospectivo, com abordagem quantitativa, no qual 102 pacientes foram submetidos a procedimentos minimamente invasivos de forma direta e de forma videoassistida. Foram avaliadas variáveis clínicas, operatórias e evolução imediata dos pacientes operados. Resultados: Quatorze pacientes foram submetidos a procedimentos minimamente invasivos diretos e 88 a videoassistidos. Entre os submetidos a procedimentos minimamente invasivos diretos, 13 tinham cardiopatia valvar aórtica. Entre os submetidos a procedimentos minimamente invasivos videoassistidos, 43 tinham cardiopatia valvar mitral, 41 defeito do septo interatrial e quatro tumores. Entre os portadores de cardiopatia valvar mitral, foram realizadas 26 trocas e 17 reconstruções valvares. As médias de tempo de clampeamento aórtico, de extracorpórea e do procedimento foram, respectivamente, 91,6 ± 21,8, 112,7 ± 27,9 e 247,1 ± 20,3 minutos entre os submetidos a procedimentos minimamente invasivos diretos. Já entre os submetidos a procedimentos minimamente invasivos videoassistidos, foram 71,6 ± 29, 99,7 ± 32,6 e 226,1 ± 42,7 minutos, respectivamente. Considerando os tempos de terapia intensiva e de internamento, foram 41,1 ± 14,7 horas e 4,6 ± 2 dias entre os submetidos a procedimentos minimamente invasivos diretos e 36,8 ± 16,3 horas e 4,3 ± 1,9 dias entre os videoassistidos. Conclusão: Procedimentos minimamente invasivos foram empregados de duas formas - direta e videoassistida - com segurança no tratamento das cardiopatias ...

Background: Minimally invasive cardiovascular procedures have been progressively used in heart surgery. Objective: To describe the techniques and immediate results of minimally invasive procedures in 5 years. Methods: Prospective and descriptive study in which 102 patients were submitted to minimally invasive procedures in direct and video-assisted forms. Clinical and surgical variables were evaluated as well as the in hospital follow-up of the patients. Results: Fourteen patients were operated through the direct form and 88 through the video-assisted form. Between minimally invasive procedures in direct form, 13 had aortic valve disease. Between minimally invasive procedures in video-assisted forms, 43 had mitral valve disease, 41 atrial septal defect and four tumors. In relation to mitral valve disease, we replaced 26 and reconstructed 17 valves. Aortic clamp, extracorporeal and procedure times were, respectively, 91,6 ± 21,8, 112,7 ± 27,9 e 247,1 ± 20,3 minutes in minimally invasive procedures in direct form. Between minimally invasive procedures in video-assisted forms, 71,6 ± 29, 99,7 ± 32,6 e 226,1 ± 42,7 minutes. Considering intensive care and hospitalization times, these were 41,1 ± 14,7 hours and 4,6 ± 2 days in minimally invasive procedures in direct and 36,8 ± 16,3 hours and 4,3 ± 1,9 days in minimally invasive procedures in video-assisted forms procedures. Conclusion: Minimally invasive procedures were used in two forms - direct and video-assisted - with safety in the surgical treatment of video-assisted, atrial septal defect and tumors of the heart. These procedures seem to result in longer surgical variables. However, hospital recuperation was faster, independent of the access or pathology. .

Minimally invasive procedures - direct and video-assisted forms in the treatment of heart diseases.

BACKGROUND: Minimally invasive cardiovascular procedures have been progressively used in heart surgery. OBJECTIVE: To describe the techniques and immediate results of minimally invasive procedures in 5 years. METHODS: Prospective and descriptive study in which 102 patients were submitted to minimally invasive procedures in direct and video-assisted forms. Clinical and surgical variables were evaluated as well as the in hospital follow-up of the patients. RESULTS: Fourteen patients were operated through the direct form and 88 through the video-assisted form. Between minimally invasive procedures in direct form, 13 had aortic valve disease. Between minimally invasive procedures in video-assisted forms, 43 had mitral valve disease, 41 atrial septal defect and four tumors. In relation to mitral valve disease, we replaced 26 and reconstructed 17 valves. Aortic clamp, extracorporeal and procedure times were, respectively, 91,6 ± 21,8, 112,7 ± 27,9 e 247,1 ± 20,3 minutes in minimally invasive procedures in direct form. Between minimally invasive procedures in video-assisted forms, 71,6 ± 29, 99,7 ± 32,6 e 226,1 ± 42,7 minutes. Considering intensive care and hospitalization times, these were 41,1 ± 14,7 hours and 4,6 ± 2 days in minimally invasive procedures in direct and 36,8 ± 16,3 hours and 4,3 ± 1,9 days in minimally invasive procedures in video-assisted forms procedures. CONCLUSION: Minimally invasive procedures were used in two forms - direct and video-assisted - with safety in the surgical treatment of video-assisted, atrial septal defect and tumors of the heart. These procedures seem to result in longer surgical variables. However, hospital recuperation was faster, independent of the access or pathology.

Kidney Disease Improving Global Outcomes or creatinine kinetics criteria in acute kidney injury: a proof of concept study.

BACKGROUND: It has been recently mathematically demonstrated that the percentage increase in serum creatinine (SCr) can delay acute kidney injury (AKI) diagnosis in patients with previous chronic kidney disease (CKD). Based on creatinine (Cr) kinetics, it was suggested a new AKI classification using absolute increase in SCr elevation over specified time periods. However, this classification has not been evaluated in clinical studies. METHODS: A prospective cohort study evaluated myocardial infarction patients during the first 7 days of hospital stay with daily SCr measurements. They were classified using Kidney Disease Improving Global Outcomes (KDIGO) and Cr kinetics systems. Both classifications were compared by net reclassification improvement (NRI) and area under the receiver operator characteristic (AuROC) curve regarding hospital mortality. RESULTS: A total of 584 patients were included, of which 34.1% had previous CKD. Patients had more AKI by KDIGO than by Cr kinetics criteria (25.7 versus 18.0%, P < 0.001) and 81 patients (13.9%) had different AKI severity classification. Patients with AKI by KDIGO criteria and non-AKI by Cr kinetics had higher hospital mortality rates than patients with non-AKI using both classifications [adjusted mortality odds ratios (ORs): 4.753; 95% confidence interval (CI): 1.119-9.023, P = 0.014]. In patients with previous CKD, NRI analysis was 6.2% favoring Cr kinetics criteria. However, there was no difference using the AuROC curve analysis. In patients with no previous CKD, NRI analysis was 33.0%, favoring KDIGO, and this was in accordance with a better AuROC curve (0.828 versus 0.664, P < 0.05). CONCLUSIONS: AKI classification proposed by a Cr kinetics model can be superior when diagnosing patients with previous CKD. However, KDIGO had a better performance in patients with no previous CKD.