ABSTRACT
Overall survival of HIV-infected has increased over the last ten years. In parallel a higher need for renal replacement therapy (RRT) in this population has been more observed. RRT associated complications and outcomes greatly varied since the introduction of highly active antiretroviral therapy (HAART) and scarce data is available regarding the outcome of peritoneal dialysis (PD) in HIV-infected patients under HAART. We described 8 HIV-infected patients who were admitted at the Peritoneal Dialysis Unit at our institution from November-95 to November-07. Mean age was 40.7 +/- 5.3. Causes of end-stage renal disease were diabetes mellitus type 1 (2), focal and segmental glomerular sclerosis (2), IgA nephropathy (1) and unknown origin (3). High blood pressure was detected in 62,5% of the patients. Mean follow-up was 41.2 +/- 32.1 months (range 12-103). One, two and three year survival was 100, 62.5 and 50% respectively. Overall mortality was 62.5% and cardio-vascular events were the main cause of death (2 patients, 25%). Infective peritonitis rate was 0.36 IP/year, and Staphylococcus epidermidis was the most common pathogen identified. Hospital admission rate was 0.69 admission/year and the main cause of admission was respiratory tract infection. All patients received HAART. Lamivudine, stavudine and nelfinavir were the most frequent treatment prescribed. During the first year in PD undetectable viral load and CD4 % were not modified. A significant weight gain was observed during the first year of the study (60.6 kg. vs 64.9 kg. p > or = 0.016). Our results suggest that PD is a suitable choice for RRT in HIV-infected. Compared to previous studies, an increase in overall survival and a decrease in PD-associated complications were seen. The significance of cardio-vascular risk factors in the outcome of PD in HIV-infected patients is not completely determined. A multidisciplinary approach and a management of patients in individual basis remains mandatory.
Subject(s)
HIV Infections/mortality , Peritoneal Dialysis , Adult , Female , HIV Infections/drug therapy , Humans , Male , Middle Aged , Peritoneal Dialysis/adverse effects , Survival RateABSTRACT
BACKGROUND: The goal of this research is to make a comparative analysis of acute tubular necrosis (NTA) incidence in function of preservation solution used: Wisconsin vs Celsior. METHODS: From January 1994 to December 2002, 229 kidney transplantation procedures were executed; 190 of them were perfused with Wisconsin (82.9%) and 39 with Celsior (17.1%). After checking the statistical homogeneity of both groups, we analysis comparatively the incidence of NTA and the evolution of serum creatinine in function of preservation solution utilized. RESULTS: There was not statistical significant difference in NTA incidence between Celsior (23%) and Wisconsin group (36%). We assessed that each group were comparable with regard to NTA incidence of subgroups with cold ischemia times longer 12 hours. Creatinine serum in Celsior group tended to be lower than Wisconsin group at 1, 3, 6 and 12 months posttransplantation (statistically significant difference, p<0.05) CONCLUSIONS: Kidney preservation in Celsior solution provides similar results to the ones obtained in Wisconsin solution in relation with NTA incidence and kidney function with the added advantage of a lower cost.
Subject(s)
Adenosine , Allopurinol , Disaccharides , Electrolytes , Glutamates , Glutathione , Histidine , Insulin , Kidney Transplantation , Mannitol , Organ Preservation Solutions , Raffinose , Adenosine/adverse effects , Adult , Allopurinol/adverse effects , Disaccharides/adverse effects , Electrolytes/adverse effects , Female , Glutamates/adverse effects , Glutathione/adverse effects , Histidine/adverse effects , Humans , Incidence , Insulin/adverse effects , Ischemic Preconditioning , Kidney Transplantation/physiology , Kidney Tubular Necrosis, Acute/chemically induced , Kidney Tubular Necrosis, Acute/epidemiology , Male , Mannitol/adverse effects , Middle Aged , Organ Preservation Solutions/adverse effects , Raffinose/adverse effects , Retrospective Studies , Time FactorsABSTRACT
OBJETIVOS: Analizar comparativamente la incidencia de necrosis tubular aguda (NTA) y función del injerto renal según el líquido de preservación empleado. Wisconsin vs Celsior. MATERIAL Y MÉTODOS: Desde enero de 1994 a diciembre de 2002 se implantaron 229 injertos renales, 190 de ellos preservados con Wisconsin (82,9 por ciento) y 39 con Celsior (17,1 por ciento). En este trabajo, tras comprobar la homogeneidad estadística de ambos grupos, se analiza comparativamente la incidencia de NTA y la evolución de la creatinina sérica en función del líquido de preservación empleado. RESULTADOS: No hay diferencia significativa en la incidencia de NTA entre los grupos Celsior (23 por ciento) y Winsconsin (36 por ciento). Se obtiene resultado similar en proporción de NTA en el subgrupo de injertos con periodos de isquemia fría superior a 12 h, con independencia del líquido de preservación empleado. El grupo Celsior presenta menores niveles de creatinina sérica a 1, 3, 6 y 12 meses postransplante renal, con una diferencia estadística significativa (p<0,05). CONCLUSIONES: La preservación renal con Celsior proporciona resultados equivalentes a Wisconsin en relación a incidencia de NTA y función renal, con la ventaja de un menor coste (AU)
