Effect of altitude on mortality of end-stage renal disease patients on hemodialysis in Peru.

BACKGROUND: In Latin America, the prevalence of end-stage kidney disease (ESKD) has risen tremendously during the last decade. Previous studies have suggested that receiving dialysis at high altitude confers mortality benefits; however, this effect has not been demonstrated at >2000 m above sea level (masl) or in developing countries. METHODS: This historical cohort study analyzed medical records from six Peruvian hemodialysis (HD) centers located at altitudes ranging from 44 to 3827 masl. Adult ESKD patients who started maintenance HD between 2000 and 2010 were included. Patients were classified into two strata based on the elevation above sea level of their city of residence: low altitude (<2000 masl) and high altitude (≥2000 masl). Death from any cause was collected from national registries and Cox proportional hazards models were built. RESULTS: A total of 720 patients were enrolled and 163 (22.6%) resided at high altitude. The low-altitude group was significantly younger, more likely to have diabetes or glomerulonephritis as the cause of ESKD and higher hemoglobin. The all-cause mortality rate was 84.3 per 1000 person-years. In the unadjusted Cox model, no mortality difference was found between the high- and low-altitude groups {hazard ratio [HR] 1.20 [95% confidence interval (CI) 0.89-1.62]}. After multivariable adjustment, receiving HD at high altitude was not significantly associated with higher mortality, but those with diabetes as the cause of ESKD had significantly higher mortality [HR 2.50 (95% CI 1.36-4.59)]. CONCLUSIONS: In Peru, patients receiving HD at high altitudes do not have mortality benefits.

Sodium chloride 0.9% versus Lactated Ringer in the management of severely dehydrated patients with choleriform diarrhoea.

INTRODUCTION: Although experience within Peru suggests clinical and physiological benefits of treating dehydration caused by diarrhoea with Lactated Ringer's solution (LR) over sodium chloride 0.9%, (NaCl) there is little documented scientific evidence supporting this view. It is important to clarify this issue and determine the best solution for use during epidemics. METHODOLOGY: Forty patients suffering from dehydration due to choleriform diarrhoea were enrolled in the study. Twenty patients were treated using NaCl (Group A) and the other twenty with LR (Group B). After diuresis recovery was achieved, the patients were continued on a course of oral rehydration salts. Serum electrolytes, arterial pH, HCO3-, and pCO2 were measured at three stages: at admission, after diuresis recovery, and after 12 hours. RESULTS: Acidosis was corrected more quickly with LR that NaCl. The hyperosmolality and hypernatremic states were corrected with both solutions. CONCLUSION: LR use resulted in a better clinical response than NaCl, illustrated by more rapid physiological correction, showing that mixed metabolic acidosis was corrected more quickly and more appropriately with this treatment.

Efectos de la expansión endovenosa rápida con solución Hartmann y con cloruro de sodio al 0.9 por ciento, sobre el medio interno de pacientes con deshidratación severa por diarrea aguda coleriforme / Effects of fast intravenous expansion with Hartmann's solution and sodium chloride at 0.9 per cent on the internal milieo, in patients with cholera like diarrhea

Objetivo: comparar el efecto de la expansión endovenosa rápida con ClNa al 0.9 por ciento y solución Hartmann, sobre la acidosis metabólica y los niveles de electrolitos plasmáticos en pacientes con deshidrataciónn severa por diarrea coleriforme. Material y métodos: se evaluaron prospectivamente 13 pacientes con deshidratación severa por enfermedad diarreica aguda compatible con cólera, que acudieron al Hospital Nacional Cayetano Heredia en febrero de 1994. Los pacientes fueron adultos entre 14 y 60 años, 7 pacientes fueron expandidos con ClNa al 0.9 por ciento y 6 con solución Hartmann a un flujo de 50 cc/Kg/hora endovenoso hasta recuperar diuresis. Resultados: las condiciones basales de ambos grupos fueron iguales, los resultados postmicción, cuando eran expandidos con ClNa fueron: el Na+: 148ñ1.60 mEq/L, el Cl-: 118ñ2.99 mEq/L, la osmolalidad: 299ñ3.97, el pH: 7.23ñ0.07, el HCO3-: 13.3ñ3.10 mEq/L; y cuando eran expandidos con solución Hartmann fueron: el Na+: 142ñ2.29 mEq/L, el Cl-: 109ñ2.74 mEq/L, la osmolalidad: 290ñ4.33, el pH: 7.37ñ0.07 y el HCO3-: 16.1ñ1.36 mEq/L. Se muestra las diferencias y los beneficios de usar la solución Hartmann en la fase de expansión rápida