Hypokalemia and hyperkalemia in patients on peritoneal dialysis: incidence and associated factors.

BACKGROUND: Hypokalemia is a well-described electrolyte disturbance in patients on peritoneal dialysis (PD). Hyperkalemia, however, is still overlooked, although it also represents a risk factor for mortality. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (ACE/ARB), diuretics, and proton pump inhibitor (PPI) can interfere with potassium levels in these patients. METHODS: This is a retrospective study that evaluated monthly serum potassium in a 5-year period. Serum potassium disturbances were evaluated as time-average and number of hypo- and hyperkalemia episodes per patient. Prescribed medication such as ACE/ARB, diuretics, and omeprazole were recorded. RESULTS: We evaluated 2025 potassium measurements obtained from 146 patients on PD. Serum potassium ranged from 2.5 to 8.3 mEq/L with an average of 4.72 ± 0.74 mEq/L. Hypokalemia was found in 59 measurements (2.9%) obtained from 35 patients (23.9%) whereas hyperkalemia was demonstrated in 269 (13.3%) measurements obtained from 74 patients (50.7%). Hypokalemia was associated with low albumin (p = 0.022), and omeprazole use (p = 0.024). Black race was a protector factor (p = 0.031). Omeprazole-associated hypokalemia was seen only in non-anuric patients and remained an independent risk factor even after adjustments. Patients who had hyperkalemia were more likely to be anuric (p = 0.001) and in use of furosemide (p = 0.0001). CONCLUSION: Hyperkalemia and hypokalemia are very frequent in patients on PD and should be closely monitored. Interventional studies should address the impact of discontinuing omeprazole in the levels of potassium.

Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism.

BACKGROUND: Secondary hyperparathyroidism (SHPT) and its associated abnormalities in mineral metabolism increase the risk of cardiovascular morbidity and death in chronic renal failure (CRF). The effect of parathyroidectomy (PTX) on the incidence of major cardiovascular events in CRF patients with SHPT is unknown. We tested the hypothesis that PTX reduces the incidence of cardiovascular complications and death in CRF patients with severe SHPT scheduled for PTX, comparing the outcome of patients treated or not treated by PTX. METHODS: The study comprised 118 CRF patients with SHPT on maintenance hemodialysis, unresponsive to medical treatment and scheduled for PTX. Patients underwent comprehensive cardiovascular evaluations at baseline. They were followed up until death, occurrence of major cardiovascular events, or kidney transplantation. RESULTS: No deaths related to PTX occurred. After a median follow-up of 30 months, 50 patients (42%) had undergone PTX whereas 68 (58%) had not. The groups were comparable in terms of age, sex, race, serum parathyroid hormone, calcium or phosphate, calcium x phosphate product, and all major cardiovascular variables, except diastolic blood pressure. PTX was associated with a reduced incidence of major cardiovascular events (P = .02) and overall mortality (P

Leaching and half-life of the herbicide tebuthiuron on a recharge area of Guarany aquifer in sugarcane fields in Brazil.

This study was undertaken to evaluate the degradation and mobility of the herbicide tebuthiuron (N-[5-(1,1-dimethylethyl)-1,3,4-thiadiazol-2-yl]-N,N'-dimethylurea) in soil under field conditions, and its potential for leaching and groundwater contamination. A watershed, Espraiado, located over a recharge area in Brazil, was chosen for soil and water studies. At Espraiado, water samples were collected from seven wells at intervals of three months from March 2004 to June 2006 and analyzed for tebuthiuron. Other samples were taken from city wells located outside of the recharge area. To assess the potential movement to the aquifer, tebuthiuron was also applied to trial plots at the recommended label rate of 1.0 kg/ha a.i. in May of 2004, with and without sugarcane coverage, on sandy soil. Soil samples were collected during the years of 2004 and 2005, at depths intervals of 20 cm from soil surface down to 120 cm and analyzed for tebuthiuron at zero, 3, 30, 60, 90, 120, 150, 180, 240, and 300 days after application. There was no clear effect of sugarcane coverage on the tebuthiuron degradation in soils, but it moved faster into the soil where there was no cover. After 180 days there were no measurable residues in the soil, and tebuthiuron was not found below 40 cm depth in any time. Tebuthiuron had a half-life of 20 days under those conditions. No tebuthiuron residue was found in ground water samples at any sampling time.

Abscesso retrofaríngeo pós adenoidectomia / Retropharyngeal abscess after adenoidectomy

Neste trabalho descreveremos um caso de abscesso retrofaríngeo associado à subluxaçäo atlanto-axial pós adenoidectomia. O paciente apresentou evoluçäo favorável com a instituiçäo de antibioticoterapia sistêmica e drenagem cirúrgica. Este tipo de complicaçäo ocorrida após adenoidectomia é bastante rara, devendo o otorrinolaringologista estar atento à mesma. As principais causas de abscesso retrofaríngeo encontradas na bibliografia form: trauma e ingestäo de corpo estranho. As principais complicaçöes pós adenoidectomia encontradas incluiam sangramento, reaçöes referentes ao agente anestésico, hipernasalidade, otalgia, cervicalgia e estenose nasofaríngea.

Nível sanguíneo de ciclosporina: método policlonal e rejeiçäo aguda pós-transplante renal / Blood level of cyclosporine: polyclonal method and acute rejection after kidney transplantation

Os níveis sanguíneos de ciclosporina (CsA) determinados pelo Kit Policlonal Sandoz e sua correlaçäo com presença ou näo de rejeiçäo aguda nos primeiros 30 dias pós-transplante foram analisados em 34 paciente. Consideramos, nos casos de rejeiçäo, aqueles níveis avaliados nos sete dias que antecederam a crise. Todos os pacientes estavam recebendo esquema tríplice de imunossupressäo e o doador era relacionado em 17 casos, cadáver em 10 e vivo näo relacionado em sete. Vinte e seis pacientes eram adultos e oito, crianças. Nas ocasiöes em que houve rejeiçäo aguda, o nível de ciclosporina foi inferior a 300ng/ml em 20 casos (80%) e nas 45 vezes sem rejeiçäo o nível foi superior a 300 ng/ml em 19 casos (42,1%); X* = 3,523; p = 0,0572. Quando consideramos o nivel inferior a 400 ng/ml, houve diferença (X* = 1,921). A dose de CsA em mg por Kg de peso näo foi diferente nos pacientes com e sem rejeiçäo, 6,3 ñ 1,4 no 1§ grupo e 6,8 ñ 1,9 no 2§ grupo. O nível sanguíneo de CsA no grupo com rejeiçäo foi de 223 ñ 220ng/ml e no grupo sem rejeiçäo, 355 ñ 325ng/ml (p = 0,071). Concluímos que o nível sanguíneo de CsA medido pelo Kit Policonal acima de 300ng/ml é aquele que mais protege o rim da rejeiçäo e este näo precisa ser superior a 300ng/ml. Näo houve diferença entre a dose por Kg de peso nos dois grupos, com e sem rejeiçäo, justificando a necessidade de dosagem do nível sanguíneo de CsA