RESUMO
Conventional hemodialysis (HD) is the most common treatment modality used for renal replacement therapy. The concept of HD is based on the diffusion of solutes across a semipermeable membrane. Hemofiltration (HF) is based on convective transport of solutes; hemodiafiltration (HDF) is based on combined convective and diffusive therapies. Data about survival benefit of on-line HDF (OL-HDF) over high-flux HD (HF-HD) is conflicting. We conducted this study to investigate if there is a survival difference between the two treatment modalities. This study is a retrospective, single-center study in which 78 patients were screened; 18 were excluded and 60 patients were analyzed. The study patients were aged 47.5 ± 20.7 years, 33 patients (55%) were on HF-HD, and 27 patients (45%) were on OL-HDF. A total of 24 patients (40%) of both groups were diabetic and, the mean duration on dialysis was 43.5 ±21.3 months in the HF-HD group and 41.2 ± 22.0 months in the OL-HDF group. The mean substitution volume for OL-HDF was 22.3 ± 2.5 L. Survival was 73% [95%, confidence interval (CI) 60-84] in the HF-HD group and 65% (95%, CI 54-75) in the OL-HDF group by the end of the study period. The unadjusted hazard ratio (HR) with 95% CI comparing HF-HD to high-volume postdilution OL-HDF was 0.78 (0.10-5.6; P = 0.810). Kaplan-Meier analysis for patient survival over five years showed no significant difference between the two modalities. Prospective controlled trials with a larger number of patients will be needed to assess the long-term clinical outcome of postdilution OL-HDF over HF-HD.
Assuntos
Hemodiafiltração , Falência Renal Crônica/terapia , Diálise Renal , Adulto , Idoso , Feminino , Hemodiafiltração/efeitos adversos , Hemodiafiltração/mortalidade , Humanos , Rim/fisiopatologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Arábia Saudita , Fatores de Tempo , Resultado do TratamentoRESUMO
Summary We report a case of a 56-year-old woman with a high-grade diffuse large B-cell lymphoma who unexpectedly developed toxic plasma levels of methotrexate (MTX) following the first cycle of rituximab-cyclophosphamide, hydroxydanorubicin, oncovin, prednisolone (R-CHOP) with a high-dose MTX chemotherapy protocol. She also developed non-oliguric acute kidney injury secondary to MTX nephrotoxicity. We elected to treat her with online-haemodiafiltration (HDF) and this proved to be efficient with a dramatic response. Rapid clearance of MTX to therapeutic levels was possible within three sessions. Prompt therapy with high-volume online-HDF is an effective choice for rapid MTX clearance and swift reversal of MTX nephrotoxicity.
Assuntos
Injúria Renal Aguda/terapia , Antimetabólitos Antineoplásicos/intoxicação , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Hemodiafiltração , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Metotrexato/intoxicação , Intoxicação/terapia , Injúria Renal Aguda/induzido quimicamente , Anticorpos Monoclonais Murinos/uso terapêutico , Antimetabólitos Antineoplásicos/sangue , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Feminino , Humanos , Metotrexato/sangue , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Rituximab , Resultado do Tratamento , Vincristina/uso terapêuticoRESUMO
Preserved anatomical integrity of the anterior abdominal wall is considered important in the presurgical evaluation of a patient who is being considered for placement of a peritoneal dialysis (PD) catheter. Diastasis recti abdominis (DRA) is the excessive widening or separation between the two bellies of the rectus abdominis muscle. The separation can occur anywhere along the linea alba and at times has been found to span the entire length from the xiphosternal angle to the pubic bone. Presence of DRA can pose a surgical challenge in the peritoneoscopic placement of peritoneal dialysis catheter. In this report, we discuss a case of successful placement of peritoneal dialysis catheter with peritoneoscope technique and successful initiation of peritoneal dialysis in a chronic kidney disease patient with DRA.
Assuntos
Cateterismo/métodos , Endoscópios , Doenças Musculares/complicações , Diálise Peritoneal , Reto do Abdome , Idoso , Humanos , Insuflação , Masculino , Cavidade Peritoneal , Insuficiência Renal Crônica/terapiaRESUMO
Rupture of the spleen is a life threatening condition. We report a 40-year-old fe-male patient, a known case of lupus nephritis receiving hemodialysis, who developed spontaneous rupture of the spleen during the course of her illness. The patient was managed conservatively with gradual regression of hematoma without further complications.
Assuntos
Nefrite Lúpica/complicações , Ruptura Espontânea/etiologia , Ruptura Esplênica/etiologia , Adulto , Feminino , Hemoglobinas/metabolismo , Humanos , Nefrite Lúpica/sangue , Nefrite Lúpica/terapia , Diálise Renal , Ruptura Espontânea/terapia , Ruptura Esplênica/terapia , Resultado do TratamentoRESUMO
BACKGROUND: The incidence of Kaposi's sarcoma (KS) in Sudanese renal transplant recipients is not known. METHODS: We retrospectively assessed the prevalence of KS in 30 Sudanese renal transplant recipients followed for 16 years. RESULTS: Four patients (13.3%) developed KS within 4-36 months after transplantation. All patients were HIV negative. CONCLUSIONS: The incidence of KS in Sudanese renal transplant recipients is very high, supporting the theory of racial or geographic factors in its genesis.