ABSTRACT
The recent research findings concerning syndromes of muscle wasting, malnutrition, and inflammation in individuals with chronic kidney disease (CKD) or acute kidney injury (AKI) have led to a need for new terminology. To address this need, the International Society of Renal Nutrition and Metabolism (ISRNM) convened an expert panel to review and develop standard terminologies and definitions related to wasting, cachexia, malnutrition, and inflammation in CKD and AKI. The ISRNM expert panel recommends the term 'protein-energy wasting' for loss of body protein mass and fuel reserves. 'Kidney disease wasting' refers to the occurrence of protein-energy wasting in CKD or AKI regardless of the cause. Cachexia is a severe form of protein-energy wasting that occurs infrequently in kidney disease. Protein-energy wasting is diagnosed if three characteristics are present (low serum levels of albumin, transthyretin, or cholesterol), reduced body mass (low or reduced body or fat mass or weight loss with reduced intake of protein and energy), and reduced muscle mass (muscle wasting or sarcopenia, reduced mid-arm muscle circumference). The kidney disease wasting is divided into two main categories of CKD- and AKI-associated protein-energy wasting. Measures of chronic inflammation or other developing tests can be useful clues for the existence of protein-energy wasting but do not define protein-energy wasting. Clinical staging and potential treatment strategies for protein-energy wasting are to be developed in the future.
Subject(s)
Cachexia/classification , Kidney Diseases/complications , Malnutrition/classification , Wasting Syndrome/classification , Acute Disease , Cachexia/diagnosis , Cachexia/etiology , Chronic Disease , Energy Metabolism , Humans , Inflammation/classification , Inflammation/diagnosis , Inflammation/etiology , Malnutrition/diagnosis , Malnutrition/etiology , Proteins/metabolism , Syndrome , Terminology as Topic , Wasting Syndrome/diagnosis , Wasting Syndrome/etiologySubject(s)
Aging/physiology , Adult , Age Factors , Aged , Aged, 80 and over , Aging/immunology , Apoptosis , Biochemical Phenomena , Biochemistry , Biological Clocks , Cardiovascular Physiological Phenomena , Cell Death , Glomerular Filtration Rate/physiology , Humans , Kidney/physiology , Kidney Diseases/etiology , Middle Aged , PharmacokineticsABSTRACT
In the last decade Peritoneal Dialysis treatment has grown specially due to the new technique known as CAPD. However, there are still a lot of problems that need to be solved such as: infection rate, new solutions and improvement of catheters and devices in order to make it safer and to decrease the complications resulted from variants called Peritoneal Dialysis on Alternate Days (PDAD) and Equilibrium Peritoneal Dialysis used in the cases of acute renal failure. Improved PD is suitable to treat the patients in many parts of the world who do not receive any treatment at present.
Subject(s)
Peritoneal Dialysis/trends , Acute Kidney Injury/therapy , Catheterization , Humans , Kidney Failure, Chronic/therapy , Peritoneal Dialysis/adverse effects , Peritoneal Dialysis/methods , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritoneal Dialysis, Continuous Ambulatory/methods , Peritonitis/prevention & control , Solutions , Time FactorsABSTRACT
The author summarizes a number of blood detoxification procedures with emphasis on hemoperfusion, hemodialysis and chronic ambulatory peritoneal dialysis.
Subject(s)
Blood , Kidney Diseases/therapy , Ultrafiltration , Hemoperfusion , Humans , Membranes, Artificial , Peritoneal Dialysis, Continuous Ambulatory , Plasma Exchange , Plasmapheresis , Renal DialysisSubject(s)
Peritoneal Dialysis/methods , Adolescent , Adult , Aged , Blood Pressure , Carbon Dioxide/blood , Creatinine/blood , Female , Furosemide/therapeutic use , Humans , Urea/bloodSubject(s)
Peritoneal Dialysis , Poisoning/therapy , Animals , Dogs , Furosemide/therapeutic use , Hemoperfusion , Humans , Patient Care Planning , Renal Dialysis , SolutionsABSTRACT
We show our experience in 12 patients treated during a year with weekly intermittent dialysis whit a rigid catheter for 36 hours a week. Patients were on a diet of 50 g. of proteins a day, normocaloric without sodium or fluid restriction. They received supplementation whith iron, calcium, vitamins B, C and folic acid, anabolic hormonal and, in some cases, furosemide hypotensives and antibiotics. Patients received the procedure for a mean of 8 months. The results show the following mean values: blood pressure: 143 +/- 12/99 +/- 3 mm. Hg., plasma urea 208 +/- 62 ng./dl.; creatinine 21 +/- 2 mg./dl., hematocrit 25 mm. and 8.0 g. hemoglobin. There was light increase of glucose, K, P, Mg, alkaline phosphatase. Na, CO2, proteins cholesterol, albumin and Ca keep in normal values. Nine patients passed to hemodialysis after a mean period of nine months and three of them received a kidney transplant. Three are still in peritoneal dialysis, one of them for 18 months. We compared our results with a similar group of patients who were treated with non-regular peritoneal dialysis. Our group had less cardiovascular complaints, or infections and keep more adequate body weight, and also got more survival in better conditions with less days in hospital, they received less blood transfusion. We concluded that weekly peritoneal dialysis is an alternative method of treatment in uremic patients for longer period of time even though frequently paracentesis.
