Subject(s)
Hyperparathyroidism, Secondary , Receptors, Calcitriol , Calcium/metabolism , Humans , Hyperparathyroidism, Secondary/drug therapy , Hyperparathyroidism, Secondary/etiology , Hyperparathyroidism, Secondary/metabolism , Parathyroid Hormone/metabolism , Pharmacogenetics , Receptors, Calcitriol/genetics , Receptors, Calcitriol/metabolism , Renal Dialysis , Vitamin D , Vitamin D-Binding Protein/genetics , Vitamin D-Binding Protein/metabolismABSTRACT
BACKGROUND AND AIMS: A bicarbonate dialysate acidified with citrate (CD) has been reported to have local anticoagulant effect and improves biocompatibility. This study examines the effect of CD on dialysis efficiency, coagulation, acid-base status, electrolytes, and inflammation in patients in on-line hemodiafiltration (OL-HDF). METHODS: 35 patients in OL-HDF were enrolled in a prospective, cross-over study for a 24-week period and two phases alternating CD and acetate dialysate fluid (AD). Parameters on study were predialysis levels of bicarbonate and ionic calcium, reactive C Protein (CRP), and beta-2 microglobulin (B2MG) and postdialysis levels of activated tromboplastine time, bicarbonate, and ionized calcium. RESULTS: No significant differences in coagulation parameters, pH, and predialysis bicarbonate were found. The postdialysis bicarbonate and postdialysis calcium were lower with CD. Dialysis efficiency was greater with CD. Regarding inflammatory parameters, both CRP and B2MG were lower using CD. CONCLUSION: The use of CD is safe and effective in OL-HDF, and it improves dialysis efficacy, postdialysis alkalosis, and inflammation.
Subject(s)
Acetates/therapeutic use , Acid-Base Imbalance/therapy , Citrates/therapeutic use , Dialysis Solutions/therapeutic use , Hemodiafiltration/methods , Acid-Base Imbalance/blood , Acid-Base Imbalance/pathology , Adult , Aged , Aged, 80 and over , Bicarbonates/blood , C-Reactive Protein/metabolism , Calcium/metabolism , Cross-Over Studies , Dialysis Solutions/chemistry , Humans , Hydrogen-Ion Concentration , Male , Middle Aged , Partial Thromboplastin Time , Prospective Studies , beta 2-Microglobulin/metabolismABSTRACT
BACKGROUND AND OBJECTIVES: Hyperparathyroidism (HPT) in chronic kidney disease (CKD) may alter the composition and bone architecture, and cause fractures. The DEXA bone mineral density (BMD), used to predict fracture risk, measures the amount of calcium in bone. However, we do not know the relationship between BMD and bone composition. PATIENT AND METHOD: Our study, conducted in two groups of renal patients with HPT who underwent parathyroidectomy (PTX): patients on hemodialysis (HD group) and patients with renal transplant (RT group). The aims were to quantify and value the differences among groups and by gender on bone mineral density, quantify and define differences between these two groups and a control group regarding the elemental composition of bone marrow biopsy obtained and static parameters of bone histomorphometry, and define a possible relationship between bone mineral density and bone elements versus histomorphometric parameters. RESULTS: The BMD mean in femur was higher in TR group than in HD group. Linear correlation analysis performed between parameters versus BMD and bone histomorphometry elements, considering both TR and HD, only correlation between femur BMD (gr/cm2) and calcium (r=0.435, p=0.034, n=24) was observed. CONCLUSION: Hyperparathyroidism patients undergoing renal transplant had better femoral BMD than those on hemodialysis; the trabecular volume was lower in kidney transplantation, while the volume of fibrosis was higher in hemodialysis patients; the elements in bone transplant and hemodialysis were in similar proportion, while the calcium content tended to be higher in renal transplant.
Subject(s)
Bone Density , Hyperparathyroidism, Secondary/metabolism , Hyperparathyroidism, Secondary/surgery , Parathyroidectomy , Adult , Female , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/metabolism , Male , Middle AgedABSTRACT
One hundred and four patients receiving hemodialysis and undergoing anaemia treatment with darbepoetin alfa intravenously once weekly were switched to a biweekly dosing schedule and followed for 24 weeks. The darbepoetin alfa dose was adjusted to maintain the target Hb concentration of 11-14 g/dL. A significant decline in the erythropoiesis-stimulating agent resistance index was observed over the 24-week follow-up, beginning with week 16, whereas the mean dose of darbepoetin alfa did not change significantly after switching to the biweekly dosing schedule. Other factors that might affect resistance to erythropoiesis remained unchanged.
Subject(s)
Anemia/drug therapy , Anemia/etiology , Erythropoietin/analogs & derivatives , Hematinics/administration & dosage , Hematinics/therapeutic use , Kidney Failure, Chronic/complications , Renal Dialysis , Darbepoetin alfa , Drug Administration Schedule , Drug Resistance , Erythropoietin/administration & dosage , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Se revisan 50 historias clínicas de pacientes asegurados intervenidos de glaucoma mediante la técnica de trabeculectomía entre los años 1980-1985 de los cuales fueron operados 60 ojos comprobándose que 4 casos evolucionaron a catarata (fase evolutiva). Se presenta esta revisión para demostrar el porcentaje encontrado en nuestra casuística (6.6%) de ojos trabeculectomizados que presentaron esta complicación
