Systematic review of the biological variation data for diabetes related analytes.

BACKGROUND: Objective interpretation of laboratory test results used to diagnose and monitor diabetes mellitus in part requires the application of biological variation data (BVD). The quality of published BVD has been questioned. The aim of this study was to quality assess publications reporting BVD for diabetes-related analytes using the Biological Variation Data Critical Appraisal Checklist (BIVAC); to assess whether published BVD are fit for purpose and whether the study design and population attributes influence BVD estimates and to undertake a meta-analysis of the BVD from BIVAC-assessed publications. METHODS: Publications reporting data for glucose, HbA1c, adiponectin, C-peptide, fructosamine, insulin like growth factor 1 (IGF-1), insulin like growth factor binding protein 3 (IGFBP-3), insulin, lactate and pyruvate were identified using a systematic literature search. These publications were assessed using the BIVAC, receiving grades A, B, C or D, where A is of highest quality. A meta-analysis of the BVD from the assessed studies utilised weightings based upon BIVAC grades and the width of the data confidence intervals to generate global BVD estimates. RESULTS: BIVAC assessment of 47 publications delivered 1 A, 3 B, 39C and 4 D gradings. Publications relating to adiponectin, C-peptide, IGF-1, IGFBP-3, lactate and pyruvate were all assessed as grade C. Meta-analysis enabled global BV estimates for all analytes except pyruvate, lactate and fructosamine. CONCLUSIONS: This study delivers updated and evidence-based BV estimates for diabetes-related analytes. There remains a need for delivery of new high-quality BV studies for several clinically important analytes.

External quality assurance programs as a tool for verifying standardization of measurement procedures: Pilot collaboration in Europe.

INTRODUCTION: Current external quality assurance schemes have been classified into six categories, according to their ability to verify the degree of standardization of the participating measurement procedures. SKML (Netherlands) is a Category 1 EQA scheme (commutable EQA materials with values assigned by reference methods), whereas SEQC (Spain) is a Category 5 scheme (replicate analyses of non-commutable materials with no values assigned by reference methods). AIM: The results obtained by a group of Spanish laboratories participating in a pilot study organized by SKML are examined, with the aim of pointing out the improvements over our current scheme that a Category 1 program could provide. METHOD: Imprecision and bias are calculated for each analyte and laboratory, and compared with quality specifications derived from biological variation. RESULTS: Of the 26 analytes studied, 9 had results comparable with those from reference methods, and 10 analytes did not have comparable results. The remaining 7 analytes measured did not have available reference method values, and in these cases, comparison with the peer group showed comparable results. The reasons for disagreement in the second group can be summarized as: use of non-standard methods (IFCC without exogenous pyridoxal phosphate for AST and ALT, Jaffé kinetic at low-normal creatinine concentrations and with eGFR); non-commutability of the reference material used to assign values to the routine calibrator (calcium, magnesium and sodium); use of reference materials without established commutability instead of reference methods for AST and GGT, and lack of a systematic effort by manufacturers to harmonize results. CONCLUSIONS: Results obtained in this work demonstrate the important role of external quality assurance programs using commutable materials with values assigned by reference methods to correctly monitor the standardization of laboratory tests with consequent minimization of risk to patients.

[Nutrient intake and eating habits in hemodialysis patients: comparison with a model based on mediterranean diet]. / Principales déficits del consumo alimentario de los pacientes en hemodiálisis: aproximación a un modelo de alimentación saludable basado en la dieta mediterránea.

OBJECTIVES: Inadequate nutrient intake seems to be one of the most important cause of malnutrition in hemodialysis patients. The purpose of this study was to analyse their nutrient intake and eating habits, comparing food groups' intake with standard Mediterranean diet values (Healthy Diet Guide 2004, Nutrition Community Spanish Society). MATERIAL AND METHODS: There were 28 stable hemodialysis (HD) patients, 15 males and 13 females, mean age 62,9 +/- 16 years. Dietary evaluation was based on 7-day dietary recalls conducted by a single observer. We compare nutrients intake with recommended hemodialysis intake and we contrast food groups consumption with the theoretical ideal based on Mediterranean diet. RESULTS: The protein intake was 1,33 +/- 0,2 g/kg/day and the energy intake 29,5 +/- 2,1 kcal/kg/day. Carbohydrates accounted 43,1% of energy intake, proteins 19% and lipids 37,9% (55,5% monounsaturated fatty acids, 16,4% polyunsaturated fatty acids and 28,1% saturated fatty acids). Complex carbohydrates (potatoes, cereals, vegetables, fruits) and olive oil consumption was lower than that recommended to the Spanish healthy population and to the chronic hemodialysis patients. The animal protein intake (meat, fish, eggs) was correct, although excessive in red and processed meats. Results: Potatoes and cereals recommended frequency (RF) 4-6 portions/day, HD patients frequency (HDF) 4,1 portions/day; vegetables RF > 2 portions/day, HDF 1,2; fruits RF > 3 portions/day, HDF 1,3; olive oil RF 3-6 portions/day, HDF 1,5; Fish RF 3-4 portions/week, HDF 4,2; White meat RF 3-4 portions/week, HDF 1,5; Poultry RF 3-4 portions/week, HDF 2,3; Eggs RF 3-4 portions/week, HDF 3,6; Pulses RF 3-4 portions/week, HDF 1,7; Nuts RF 3-7 portions/week, HDF 0; Red meat RF occasionally, HDF 4,8 portions/week; Processed meats RF occasionally, HDF 4,6 portions/week; Sweets, snacks, soft drinks RF occasionally, HDF 1,7 portions/week; Butter, margarine, processed bakery products, biscuits RF occasionally , HDF 0,5 portions/week. CONCLUSIONS: Nutritional abnormalities are frequently found even in apparently stable patients on chronic hemodialysis. Caloric rather than protein undernutrition is the major abnormality. Inadequate caloric intake (< 35 kcal/kg/day) can lead to a negative nitrogen balance. Their eating habits are healthy and natural, but there is a deficit in slowly absorbed carbohydrates and olive oil intake (with caloric intake reduction), and an excessive consumption of red and processed meats (with saturated fats increase). The individual correction of these dietary patterns could reduce the saturated fats and increase the energy intake, obtaining a balanced diet integrated into our geographic region and culture.

Principales déficits del consumo alimentario de los pacientes en hemodiálisis: aproximación a un modelo de alimentación saludable basado en la dieta mediterránea / Nutrient intake and eating habits in hemodialysis patients: comparison with a model based on mediterranean diet

Introducción y objetivos: La dieta inadecuada desempeña un papel importante en la malnutrición del paciente en hemodiálisis periódica (HDP). El propósito de este estudio es analizar su ingesta alimentaria y hábitos dietéticos, detectando el alejamiento entre el consumo real y el aconsejado. Para ello, contrastamos el consumo alimentario por grupos de alimentos con un ideal teórico basado en la Dieta Mediterránea. Material y método: Seleccionamos pacientes en HDP en situación clínica estable y con apetito conservado. Se realiza el análisis de la ingesta alimentaria mediante el Registro de Consumo Alimentario de 7 días. Comparamos la ingesta de nutrientes y minerales con la recomendada en HDP y contrastamos el consumo por grupos de alimentos con las medias recomendadas por la Guía de la Alimentación Saludable 2004 de la Sociedad Española de Nutrición Comunitaria. Resultados: Incluimos 28 pacientes, 15 varones y 13 mujeres, con una edad media de 62,9 ± 16 años. Registramos una ingesta proteica correcta, de 1,33 ± 0,2 g/kg peso ideal/día. Sin embargo el aporte energético fue de 29,5 ± 2,1 kcal/kg de peso ideal/día, inferior al recomendado en un 16%. La distribución por principios inmediatos fue: 19% proteínas, 43,1% hidratos de carbono y 37,9% grasas (55,5% ácidos grasos monoinsaturados, 16,4% poliinsaturados y 28,1% saturados). En el consumo por raciones de grupos de alimentos encontramos un déficit en las raciones de hidratos de carbono complejos y en el consumo de aceite de oliva. El consumo proteico animal es correcto cuantitativamente, aunque excesivo en carnes rojas y embutidos. Conclusiones: En este grupo de pacientes en HDP estables, la ingesta proteica es adecuada, y la calórica insuficiente, lo que puede conducir a un balance nitrogenado negativo. En la composición por principios inmediatos, el aporte de hidratos de carbono es bajo y el de lípidos excesivo, aunque con una buena relación entre ácidos grasos mono-poliinsaturados/ saturados. En general la dieta es sana, con productos naturales, pero excesiva en carnes rojas y pobre en hidratos de carbono complejos y aceites vegetales. La corrección de estos problemas, dentro de las posibilidades de cada caso, permitiría una reducción en el consumo de grasas saturadas y un mayor aporte calórico, equilibrando la dieta con alimentos propios de nuestra zona geográfica

Objectives: Inadequate nutrient intake seems to be one of the most important cause of malnutrition in hemodialysis patients. The purpose of this study was to analyse their nutrient intake and eating habits, comparing food groups’ intake with standar Mediterranean diet values (Healthy Diet Guide 2004, Nutrition Community Spanish Society). Material and methods: There were 28 stable hemodialysis (HD) patients, 15 males and 13 females, mean age 62,9 ± 16 years. Dietary evaluation was based on 7-day dietary recalls conduced by a single observer. We compare nutrients intake with recommended hemodialysis intake and we contrast food groups consumption with the theoretical ideal based on Mediterranean diet. Results: The protein intake was 1,33 ± 0,2 g/kg/day and the energy intake 29,5 ± 2,1 kcal/kg/day. Carbohydrates accounted 43,1% of energy intake, proteins 19% and lipids 37,9% (55,5% monounsaturated fatty acids, 16,4% polyunsaturated fatty acids and 28,1% saturated fatty acids). Complex carbohydrates (potatoes, cereals, vegetables, fruits) and olive oil consumption was lower than that recommended to the Spanish healthy population and to the chronic hemodialysis patients. The animal protein intake (meat, fish, eggs) was correct, although excessive in red and processed meats. Results: Potatoes and cereals recommended frequency (RF) 4-6 portions/day, HD patients frequency (HDF) 4,1 portions/day; vegetables RF > 2 portions/day, HDF 1,2; fruits RF > 3 portions/day, HDF 1,3; olive oil RF 3-6 portions/day, HDF 1,5; Fish RF 3-4 portions/week, HDF 4,2; White meat RF 3-4 portions/week, HDF 1,5; Poultry RF 3-4 portions/week, HDF 2,3; Eggs RF 3-4 portions/week, HDF 3,6; Pulses RF 3-4 portions/week, HDF 1,7; Nuts RF 3-7 portions/week, HDF 0; Red meat RF occasionally, HDF 4,8 portions/week; Processed meats RF occasionally, HDF 4,6 portions/week; Sweets, snacks, soft drinks RF occasionally, HDF 1,7 portions/week; Butter, margarine, processed bakery products, biscuits RF occasionally , HDF 0,5 portions/week. Conclusions: Nutritional abnormalities are frequently found even in apparently stable patients on chronic hemodialysis. Caloric rather than protein undernutrition is the major abnormality. Inadequate caloric intake (< 35 kcal/kg/day) can lead to a negative nitrogen balance. Their eating habits are healthy and natural, but there is a deficit in slowly absorbed carbohydrates and olive oil intake (with caloric intake reduction), and an excessive consumption of red and processed meats (with saturated fats increase). The individual correction of these dietary patterns could reduce the saturated fats and increase the energy intake, obtaining a balanced diet integrated into our geographic region and culture

Concordancia entre las fórmulas de Cockcroft Gault y del estudio MDRD para estimar la tasa de filtración glomerular en pacientes con diabetes tipo 2 / correspondence of cockroft gault and MDRD to estimate glomerular filtration rate in patients with diabetes 2

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[Evaluation of food intake in hemodialysis using a food consumption and appetite questionnaire]. / Valoración de la ingesta en hemodiálisis mediante un cuestionario de consumo alimentario y apetito.

Protein calorie malnutrition is a common complication in chronic hemodialysis patients (CHP). Although many factors could promote malnutrition, inadequate nutrient intake seems to be one of the most important. An Appetite and Diet Assessment Questionnaire (ADAQ) was developed, and we have performed a cross-sectional study in 44 CHP to investigate its capacity to predict an inadequate intake. Dietary evaluation was based on a diet diary-assisted recalls (DDAR). On the other hand, the validity of PCR and the differences in the DDAR and ADAQ between the days of dialysis and the days without dialysis were studied. The predictive value of inadequate intake of the ADAQ and the PCR were analysed with the ROC curve. The protein intake was 1.3 +/- 0.3 g/kg/day and the energy intake 29.2 +/- 0.6 kcal/kg/day. The average PCR was 1.14 +/- 0.3. The ROC curve to predict inadequate intake from the ADAQ shows an area under the curve of 0.84 for the protein intake and 0.73 for the energy intake. A cut-off ponit of 18 gives a sensitivity of 100% and a specificity of 44% for the detection of poor protein intake (< 1.2 g/kg/day) and of 74% and 56% for the detection of poor energy intake (< 30 kcal/kg/day). The ROC curve to predict inadequate protein intake from the PCR obtains an area under the curve of 0.81. The cut-off 1.06 gives the best sensitivity (100%) and specificity (64%) for the detection of insufficient protein intake. We did not find any significant difference in the DDAR or in the ADAQ between the days of dialysis and the days without dialysis. Despite the subjective interpretation, the relationship between ADAQ and protein-energy intakes analysed by DDAR was highly significant. The questionnaire is simple and can therefore be used as a screening rest to detect and correct alterations in the diet which could otherwise lead to malnutrition. The determination of PCR gives a good sensitivity and specificity for the detection of poor protein intake, although the results are modified in anabolic or catabolic states which can clinically go undetected. We do not register differences in diet between the days of dialysis and the days without dialysis.

Epidemiología, aspectos clínicos y manejo del fracaso renal agudo en una población envejecida dependiente de un hospital comarcal / Characteristics of acute renal failure in elderly patients admitted to a small town hospital

El objetivo de nuestro trabajo es analizar las características del fracaso renal agudo (FRA) en un hospital comarcal desprovisto de unidad de cuidados intensivos que atiende a una población envejecida en una zona rural, con el fin de reconocer los factores etiológicos e instaurar medidas de prevención y tratamiento adecuadas.Revisamos de manera prospectiva todos los casos de FRA registrados a lo largo de un año. Se detectaron 99 episodios, con una incidencia de 1.238 casos por millón de población y año y un 1,78 por ciento de los pacientes ingresados. La edad media fue de 80,3 ñ 10 años. Existía importante patología asociada (hipertensión 54 por ciento, diabetes 39 por ciento) y frecuente tratamiento cardiovascular previo (bloqueo sistema renina-angiotensina 35,4 por ciento, diuréticos 50,5 por ciento). En el 79 por ciento de los casos el FRA fue extrahospitalario, y en el 21 por ciento hospitalario. El 60 por ciento fueron prerrenales, el 31 por ciento renales y el 9 por ciento obstructivos. El 44,4 por ciento fueron oligoanúricos. Entre las causas desencadenantes destacan un 34,7 por ciento por disminución de volumen circulante efectivo, un 23 por ciento por infección y un 20,4 por ciento por bajo gasto. En un 35,3 por ciento de los casos la actuación médica contribuyó a iniciar o mantener el FRA, en el extrahospitalario por tratamiento antihipertensivo y/o diurético en situaciones de depleción de volumen y en el hospitalario por mal manejo o tóxicos.El desarrollo de FRA duplicó la estancia (14,4 ñ 7 frente a 6,5 ñ 4 días) y se registró una mortalidad de 36,4 por ciento, superior en el hospitalario (54 por ciento) frente al extrahospitalario (24 por ciento, p < 0,05). Los principales factores que influyeron en la mortalidad fueron el total de patología asociada, la presencia de oligoanuria, la etiología de origen parenquimatoso y la hipoalbuminemia.Podemos concluir que el FRA presenta una elevada incidencia en esta población envejecida y una morbi-mortalidad importante. Es fundamental su detección y prevención en el ámbito extrahospitalario, con especial vigilancia de pacientes ancianos, con reducción de la reserva funcional renal por afectación vascular sistémica y tratamiento farmacológico (principalmente bloqueantes del sistema reni- na-angiotensina y diuréticos), que pueden desarrollarlo ante moderadas depleciones de volumen. En el ámbito hospitalario, es primordial el manejo adecuado de procesos que cursan con depleción de líquidos, bajo gasto cardíaco, hipoalbuminemia u otras situaciones que comportan una hipoperfusión renal y la vigilancia de la nefrotoxicidad de los fármacos, en especial los aminoglucósidos y los antiinflamatorios no esteroideos (AU)

Valoración de la ingesta en hemodiálisis mediante un cuestionario de consumo alimentario y apetito / Evaluation of nutrient intake in hemodialysis patients validity of an appetite and diet assessment and of protein catabolic rate determination

Dentro del origen multifactorial de la malnutrición en hemodiálisis periódica (HDP) la ingesta inadecuada es una causa importante, valorándose habitualmente mediante registro de consumo alimentario (RCA). Con el objetivo de detectar de forma sencilla y rápida una pobre ingesta, se desarrolla un Cuestionario de Consumo Alimentario y Apetito (CCAA) y se estima su capacidad para predecir un aporte proteico-calórico inadecuado, tomando como patrón de referencia el RCA. Así mismo se analiza la capacidad predictiva de insuficiente ingesta proteica que ofrece la tasa de catabolismo proteico (PCR) y se estudia si existen diferencias en los valores del RCA y del CCAA entre los días de diálisis y los días sin diálisis. Se incluyen en el estudio 44 pacientes en HDP en situación clínica estable. Para la evaluación de la ingesta se utilizó el método de RCA mixto (mediante pesada y entrevista) de dos días (uno de diálisis y uno de no diálisis). Se determinó el PCR y se desarrolló el CCAA, un cuestionario de 34 ítems acerca de la adecuación de la dieta y el nivel de apetito. Se realiza una baremación del CCAA y se constrastan estos datos y los valores del PCR con el RCA mediante el análisis de curva ROC. La ingesta proteica media fue de 1,3 ñ 0,3 g/kg/día y la calórica de 29,2 ñ 6 kcal/kg/día según RCA. El PCR medio fue de 1,14 ñ 0,3. Al relacionar el CCAA con el RCA obtenemos un área bajo curva de 0,84 (IC 0,70-0,93) para la ingesta proteica y de 0,73 (IC 0,57-0,85) para la calórica. El punto de corte en 18 ofrece unos valores de sensibilidad del 100 por ciento y especificidad del 44 por ciento para la detección de pobre ingesta proteica (< 1,2 g/kg/día) y del 74 por ciento y 56 por ciento para la detección de pobre ingesta calórica (< 30 kcal/kg/día). Al relacionar el PCR con la ingesta proteica según RCA obtenemos un área bajo curva de 0,81 (IC 0,660,91). El puto de corte en 1,06 nos ofrece la mejor sensibilidad (100 por ciento) y especificidad (64 por ciento) en la detección de ingesta proteica insuficiente. No encontramos diferencias significativas entre los días de diálisis y los días sin diálisis en el RCA ni en el CCAA. Consideramos que el CCAA, a pesar de la subjetividad de su interpretación, se correlaciona bien con la ingesta alimentaria analizada mediante RCA. Su realización es sencilla, por lo que puede utilizarse de forma repetitiva como screening para detectar y corregir de forma precoz alteraciones en la ingesta alimentaria que pueden conducir a déficits nutricionales. La determinación del PCR presenta una buena sensibilidad y especificidad en la detección de pobre ingesta proteica, aunque sus resultados se alteran ante estados anabólicos o catabólicos que clínicamente pueden pasar desapercibidos. No registramos diferencias en la dieta entre los días de diálisis y los días sin diálisis (AU)

[Comparison of clinical arterial pressure, home-arterial pressure measurement, and ambulatory arterial pressure monitoring in patients with type II diabetes mellitus and diabetic nephropathy]. / Comparación de presión arterial clínica, automedida domiciliaria de presión arterial y monitorización ambulatoria de presión arterial en el paciente con diabetes mellitus tipo 2 y nefropatía diabética.

BACKGROUND: Hypertension is common in type 2 diabetes with diabetic nephropathy, and increases the risk of cardiovascular complications and renal chronic insufficiency. The aim of our evaluation in these patients was: a) to study the correlation between office blood pressure (BP), self-monitored (SMBP) and 24-hour ambulatory blood pressure monitoring (ABPM). b) To study the correlation between these methods and cardiovascular and renal complications. METHODS: We studied 60 patients (mean age 66.7 +/- 9 years, mean duration of diabetes 11.3 +/- 7 years) with arterial hypertension, type 2 diabetes and diabetic nephropathy. Macroangiopathy and echocardiography were recorded. We measured, SMBP and ABPM without modifying the antihypertensive treatment. The white coat phenomenon (WCP) was determined and patients were classified as dippers or non dippers according to their blood pressure diurnal rhythm. RESULTS: Mean glycated haemoglobin was 7.8% and mean serum creatinine 1.2 +/- 0.5 mg/dl, 30% of patients had proteinuria and 70% microalbuminuria The mean number of antihypertensive drugs was 2.2 +/- 1. The mean BP was: Office BP: 158.2 +/- 24/85.3 +/- 9 mmHg, pulse pressure (PP) 72.9 +/- 21 mmHg; SMBP: 145.4 +/- 18/77.5 +/- 7 mmHg, PP 67.9 +/- 18 mmHg and BP in the early morning 150.2 +/- 20/79.9 +/- 9 mmHg; ABPM: diurnal mean 138.9 +/- 15/74.1 +/- 6 mmHg, PP 64.8 +/- 15 mmHg and BP in the early morning 146.5 +/- 16/78.5 +/- 7 mmHg. The three techniques showed a good correlation and WCP was detected in 46.7% of patients with SMBP and in 56.7% with ABPM. We found no correlation between BP and macroangiopathy, but an increase of systolic BP in SMBP and ABPM in proteinuric patients were found and correlation between mass left ventricular index (MLVI) and PP in office and systolic BP and PP in SMBP and ABPM was significant. 70% of patients were non dippers, with a higher MLVI. CONCLUSIONS: Decreases in BP in type 2 diabetes with diabetic nephropathy are difficult of maintain despite combinations of different antihypertensive drugs. These patients present an important WCP and worse prognosis data, such as elevation of systolic BP, increased PP, poor night BP fall and a BP rise in the early morning. Also, we can't reduced the BP during 24 hours in an important number of patients. These characteristics can be detected by combining the office BP measurement, SMBP and ABPM. The alternative possibility would be lifestyle modification, appropriate drug combinations and to start treatment at lower levels than those currently used as thresholds (the guidelines for antihypertensive treatment have been drastically shifted in this direction over the past years).

Comparación de presión arterial clínica, automedida domiciliaria de presión arterial y monitorización ambulatoria de presión arterial en el paciente con diabetes mellitus tipo 2 y nefropatía diabética / Comparison of office blood pressure, self-monitored blood pressure and ambulatory blood pressure in type 2 diabetes with diabetic nephropathy

Objetivo: Se estudian las características de la hipertención arterial en el paciente con diabetes mellitus (DM) tipo 2 y nefropatía diabética con el objetivo de analizar la concordancia entre la presión arterial en consulta (PAC), la automedida domiciliaria de PA (AMPA) y la monitorización ambulatoria de PA (MAPA) y el grado de asociación de las tres técnicas con la afectación cardiovascular y renal.Material y método: Los criterios de inclusión en el estudio fueron la existencia de DM tipo 2, hipertensión arterial y nefropatía diabética. Se recogen las determinaciones bioquímicas, la afectación macrovascular y se realiza ecocardiograma. Sin modificar el tratamiento antihipertensivo se determinan las cifras de PA mediante tres técnicas: PAC, AMPA y MAPA.Resultados: Se estudian 60 pacientes con una edad media de 66,7 ñ 9 años y una duración de la diabetes de 11,3 ñ 7 años. La hemoglobina glicada fue de 7,8 por ciento, la creatinina plasmática de 1,2 ñ 0,5 mg/dl, el 70 por ciento presentaban microalbuminuira y el 30 por ciento proteinuria. La media de fármacos antihipertensivos administrados fue de 2,2 ñ 1. Las cifras de PA fueron: PAC: 158,2 ñ 24 / 85,3 ñ 9 mmHg, con presión del pulso (PP) 72,9 ñ 21 mmHg; AMPA: media diurna 145,4 ñ 18 / 77,5 ñ 7 mmHg, PP 67,9 ñ 18 mmHg y toma matutina 150,2 ñ 20 / 79,9 ñ 9 mmHg; MAPA: media diurna 138,9 ñ 15 / 74,1 ñ 6 mmHg, PP 64,8 ñ 15 mmHg y media en las 2 primeras horas de la mañana 146,5 ñ 16 / 78,5 ñ 7 mmHg. Las tres técnicas mostraron buena correlación entre sí y el fenómeno de bata blanca (FBB) se detectó en un 46,7 por ciento según AMPA y en un 56,7 por ciento según MAPA. No se encuentra correlación entre las cifras de PA y la macroangiopatía, y sí mayor elevación de PAS en AMPA y MAPA en los pacientes con proteinuria NEFROLOGÍA. Vol. XXII. Número 2. 2002 y correlación significativa del índice de masa ventricular izquierda (IMVI) con la PP en consulta y con la PA sistólica y la PP en AMPA y MAPA. El 70 por ciento fue non dipper, con un mayor IMVI.Conclusiones: La hipertensión arterial en la DM tipo 2 con nefropatía diabética es difícil de controlar a pesar de la combinación de distintos fármacos antihipertensivos, presenta un importante FBB y datos de mayor agresividad como la elevación a expensas principalmente de la PA sistólica, una presión del pulso aumentada, un pobre descenso nocturno y una cifras elevadas enlas primeras horas de la mañana. Estas características suponen una dificultad añadida en su manejo y pueden ser detectadas combinando las tomas en consulta con la AMPA y la MAPA. En su control, se debe considerar la modificación del estilo de vida, una adecuada combinación de fármacos y un inicio precoz del tratamiento con umbrales de PA más bajos de los habitualmente utilizados, orientación que han tomado las guías de tratamiento antihipertensivo en los últimos años. a pesar de ello, en un número importante de pacientes no se consigue controlar de forma adecuada la PA durante las 24 horas (AU)

[Characteristics of acute renal failure in elderly patients admitted to a small town hospital]. / Epidemiología, aspectos clínicos y manejo del fracaso renal agudo en una población envejecida dependiente de un hospital comarcal.

We studied the features of acute renal failure (ARF) in elderly patients treated in a hospital, without an intensive care unit, to identify etiological factors and establish adequate preventive measures and treatment. During twelve consecutive months we studied prospectively 99 patients with ARF diagnosed by conventional criteria, an incidence of 1,238 cases per million per year. ARF affected 1.78% of patients admitted to hospital. We analyzed age, sex, serum creatinine, diuresis, etiology, type of ARF, preexisting chronic diseases, treatment, complications and outcome. Preexisting chronic diseases were common, the most frequent being hypertension (54%) and diabetes (39%). Previous treatments for cardiovascular diseases were frequent (angiotensin-renin system blockade 35.4%, diuretics 50.5%). 79% of ARF arose in hospital, 21% outside hospital. ARF was pre-renal in 60%, renal in 31% and post-renal in 9%. 34.7% were caused by volume depletion, 23.4% by low cardiac output and 23.4% by infection. 44.4% of ARF patients had oliguria or anuria latrogenic factors contributed to the ethiology of ARF in 35.3% of patients. Hospital stay was doubled by ARF the presence of ARF and the mortality was 36.4%. The rate was higher in ARF arising in hospital than in ARF acquired before admission. Factors that had a significant influence on the mortality rate were comorbid conditions, oliguroanuria, ARF of renal origin and serum albumin. We conclude that ARF has a high incidence, morbidity and mortality in this elderly population. Volume depletion, associated cardiovascular pathology and pharmacological treatment are important etiological factors in those with ARF outside hospital. Adequate treatment of ARF and avoidance of nephrotoxic medications are necessary in hospital.

[Quality control of general diets served in a county hospital]. / Control de calidad de las dietas generales servidas en un hospital comarcal.

INTRODUCTION: The general diet of a hospital, given to patients who do not require therapeutic modifications, must meet their nutritional demands. MATERIAL AND METHODS: During a 42 consecutive days period, the complete menu of a patient was randomly selected. Using a computer program based on the food composition tables, we verified whether or not the foods the patient received, met the requirements of the theoretical menus of the hospital, designed according to the international recommendations. RESULTS: The provided menus supplied 2,410 kilocalories, of which 900 (37.3%) corresponded to carbohydrates, 1,071 (44.4%) corresponded to lipids, and 439 (18.3%) corresponded to proteins. The level of cholesterol was 422 mg, and the fiber content was 20 g. These values differ significantly from the theoretical values noted previously: 2,200 kilocalories, 55% carbohydrates, 30% lipids, 15% proteins, cholesterol less than 300 mg, and 40 g of fiber (p < 0.001). Within the fats, the monounsaturated fats were the most abundant (45%). With regard to vitamins and minerals, vitamin D was the only deficient vitamin when compared to the international recommendations. CONCLUSION: We have detected that our general menus provide an excess of fats and cholesterol, as well as a deficient supply of carbohydrates, fiber, and vitamin D. We believe it necessary to carry out periodic quality controls to correct the defects that arise on translating the theoretical menus into daily practice.

Serum enzymes activities at rest and after a marathon race.

With the purpose of determining the long and short term changes in serum enzyme activities after a marathon race, a survey involving nine healthy male runners was carried out. A basal blood sample was extracted from each 24 hours prior to the race and three further extractions were made immediately after the race, as well as at 1 and a final 24 h after the end of the race. In the enzymes of preferably hepatic origin--alkaline phosphatase (AP), ganna-glutamyltransferase (GGT) and alanine aminotransferase (ALT)--scanty modifications were found and these could be related to the changes observed in the plasma volume. Enzymes such as aspartate aminotransferase (AST) and lactate dehydrogenase (LDH), which are widely distributed in the tissues, were found to have undergone more marked variations and these could not be related to the changes in the volume of the plasma, while in enzymes of muscular origin such as aldolase (ALD), creatine kinase (CK) and its cardiac isoenzyme (CK-MB), notable increases were observed due to the muscular injury suffered. The greatest example of this was the increase found in total CK 24 h after the end of the marathon (414.6%). The high serum percentages found in CK-MB in these endurance-trained runners in relation to total CK activity should be carefully assessed in order to avoid false diagnosis of acute myocardial infarction.