Impacto de la modalidad de terapia de reemplazo renal en adultos mayores frágiles / Impact of renal replacement therapy on frail older adults

INTRODUCCIÓN: La enfermedad renal crónica terminal está aumentando en los adultos mayores. La fragilidad es altamente prevalente en los adultos mayores con enfermedad renal crónica terminal. Sin embargo, no existen estudios prospectivos que comparen el rendimiento de las diferentes modalidades de terapia de reemplazo renal (TRR) en adultos mayores frágiles. OBJETIVO: Comparar la ocurrencia de resultados clínicamente relevantes (hospitalizaciones, caídas, fracturas de caderas y mortalidad) en adultos mayores prefrágiles y frágiles según modalidad de TRR: hemodiálisis o diálisis peritoneal. MÉTODO: Estudio observacional prospectivo en adultos mayores prefrágiles y frágiles (según escala FRAIL) en hemodiálisis y diálisis peritoneal en las unidades correspondientes de la Red de Salud UC-Christus. Se evaluaron características basales (edad, Charlson, índice de masa corporal, tiempo en TRR, cumplimiento de Kt/V, hemoglobina y albúmina) y se siguieron a 12 meses, registrando mortalidad, días y número de hospitalizaciones, caídas y fracturas de cadera. RESULTADOS: Cumplieron criterios de ingreso 27 pacientes por grupo. Sus características basales fueron similares, a excepción de la albuminemia y del tiempo en TRR, ambas menores en el grupo en diálisis peritoneal. La escala FRAIL fue similar. La escala FRAIL se correlacionó basalmente con mayor comorbilidad, menor albuminemia y no cumplimiento del Kt/V, mientras que fue independiente de la edad, índice de masa corporal y tiempo en TRR. Los días y número de hospitalizaciones a 12 meses fueron similares para ambas modalidades de TRR. La supervivencia de ambos grupos fue similar. No hubo diferencias en caídas y ningún paciente tuvo fracturas de cadera. CONCLUSIONES: En adultos mayores prefrágiles y frágiles la modalidad de TRR no influyó en la ocurrencia de hospitalización, mortalidad, caídas ni fracturas de cadera

INTRODUCTION: End-stage renal disease prevalence is increasing in older adults. Frailty is highly prevalent in older adults with end-stage renal disease. However, there are no prospective studies comparing the performance of the different modalities of renal replacement therapy (RRT) in frail older adults. OBJECTIVE: To compare clinically relevant outcomes (hospital admission, falls, hip fractures, and mortality) in prefrail and frail older adults according to the modality of RRT: peritoneal dialysis or haemodialysis. METHODS: A prospective observational study in prefrail and frail older adults (according to FRAIL scale) on peritoneal dialysis and haemodialysis was carried out. An evaluation was made using baseline characteristics (age, Charlson, body mass index, time on RRT, compliance with Kt/V dose, haemoglobin, and albumin). The patients were followed-up over 12 months, recording mortality, days and number of hospital admissions, falls, and hip fractures. RESULTS: A total of 54/65 (83%) older adults on RRT met criteria for prefrailty or frailty, and signed informed consent (27 in each modality). Baseline characteristics were similar, except for serum albumin and time on RRT, both of which were significantly lower in the peritoneal dialysis group. The FRAIL score was similar in both groups. Baseline FRAIL correlated with higher comorbidity, lower albumin levels, and non-compliance of Kt/V dose, while it was independent of age, body mass index, and time on RRT. Days and number of hospital admissions at 12 months were similar in patients on peritoneal dialysis and haemodialysis. Survival on peritoneal dialysis and haemodialysis was similar. There were no differences in falls or hip fractures. CONCLUSIONS: Pre-frail and frail older adults on peritoneal dialysis and haemodialysis have similar clinical outcomes

[Impact of renal replacement therapy on frail older adults]. / Impacto de la modalidad de terapia de reemplazo renal en adultos mayores frágiles.

INTRODUCTION: End-stage renal disease prevalence is increasing in older adults. Frailty is highly prevalent in older adults with end-stage renal disease. However, there are no prospective studies comparing the performance of the different modalities of renal replacement therapy (RRT) in frail older adults. OBJECTIVE: To compare clinically relevant outcomes (hospital admission, falls, hip fractures, and mortality) in prefrail and frail older adults according to the modality of RRT: peritoneal dialysis or haemodialysis. METHODS: A prospective observational study in prefrail and frail older adults (according to FRAIL scale) on peritoneal dialysis and haemodialysis was carried out. An evaluation was made using baseline characteristics (age, Charlson, body mass index, time on RRT, compliance with Kt/V dose, haemoglobin, and albumin). The patients were followed-up over 12 months, recording mortality, days and number of hospital admissions, falls, and hip fractures. RESULTS: A total of 54/65 (83%) older adults on RRT met criteria for prefrailty or frailty, and signed informed consent (27 in each modality). Baseline characteristics were similar, except for serum albumin and time on RRT, both of which were significantly lower in the peritoneal dialysis group. The FRAIL score was similar in both groups. Baseline FRAIL correlated with higher comorbidity, lower albumin levels, and non-compliance of Kt/V dose, while it was independent of age, body mass index, and time on RRT. Days and number of hospital admissions at 12 months were similar in patients on peritoneal dialysis and haemodialysis. Survival on peritoneal dialysis and haemodialysis was similar. There were no differences in falls or hip fractures. CONCLUSIONS: Pre-frail and frail older adults on peritoneal dialysis and haemodialysis have similar clinical outcomes.

[Retroperitoneal fibrosis associated with malignancies: report of eight cases]. / Fibrosis retroperitoneal asociada a neoplasias malignas: Serie de casos clínicos.

Retroperitoneal fibrosis (RPF) is uncommon. Eight percent of cases are associated with malignancies. The pathogenesis of cancer related RPF (MRPF) is unknown. It may be originated from a desmoplastic reaction of the retroperitoneum to the presence of malignant cells, to the action of cytokines secreted by the tumor or a reactive inflammation. MRPF may also be a consequence of antineoplastic therapy (surgery, radiotherapy and chemotherapy). We report eight cases of MRPF associated with breast, cervix, thyroid, kidney and retroperitoneal cancer. In four patients, retroperitoneal tissue biopsy was performed, showing the typical findings of idiopathic RPF. In 6 patients MRPF appeared one to 15 years after cancer diagnosis and in two, it appeared simultaneously. The clinical presentation, course and therapeutic response are described. Six patients were treated with steroids alone and five with steroids associated with colchicine.

Fibrosis retroperitoneal asociada a neoplasias malignas: Serie de casos clínicos / Retroperitoneal fibrosis associated with malignancies: Report of eight cases

Retroperitoneal fibrosis (RPF) is uncommon. Eight percent of cases are associated with malignancies. The pathogenesis of cancer related RPF (MRPF) is unknown. It may be originated from a desmoplastic reaction of the retroperitoneum to the presence of malignant cells, to the action of cytokines secreted by the tumor or a reactive inflammation. MRPF may also be a consequence of antineoplastic therapy (surgery, radiotherapy and chemotherapy). We report eight cases of MRPF associated with breast, cervix, thyroid, kidney and retroperitoneal cancer. In four patients, retroperitoneal tissue biopsy was performed, showing the typical findings of idiopathic RPF. In 6 patients MRPF appeared one to 15 years after cancer diagnosis and in two, it appeared simultaneously. The clinical presentation, course and therapeutic response are described. Six patients were treated with steroids alone and five with steroids associated with colchicine.