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1.
J Nephrol ; 26(1): 158-63, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22419236

RESUMO

BACKGROUND: Unfractionated heparin (UFH) is the standard anticoagulant in regular dialysis treatments (RDTs), despite the fact that it may induce thrombocytopenia, dyslipidemia, allergy and osteoporosis. Dermatan sulfate (DS) selectively inhibits thrombin, does not inhibit F-Xa and does not interfere with platelets (PLTS). Here we described an original protocol for the use of DS as anticoagulant in RDT and compared its effects with those of UFH. METHODS: In 102 patients, 7,254 RDTs were performed using DS for anticoagulation (DS-phase) and 5,707 with UFH (UFH-phase). DS was supplied as initial bolus (80 ± 12 mg) and continuous infusion (14 ± 7 mg/hour). With UFH, the initial bolus was 1,475 ± 141 IU and continuous infusion 576 ± 349 IU/hour. Activated partial thromboplastin time and its ratio were measured at least monthly, both before (pre-RDT APTT ratio) and after (post-RDT APTT ratio) RDT sessions. With 41 of 102 patients, both DS and UFH doses were not changed during study phases (stable patients). In this subset, the coefficient of variation (CV) of all pre-RDT APTT ratio and post-RDT APTT ratio values was calculated. RESULTS: In DS and UFH phases, post-RDT APTT ratio increased by 61% and 50%, respectively, by comparison with pre-RDT APTT ratio (p<0.001). PLTS count was lower in the UFH than in the DS phase (p<0.01). In stable patients, post-RDT APTT ratio CV was lower in the DS than in the UFH phase (p<0.001), which indicates a more predictable anticoagulant effect of DS compared with UFH. CONCLUSIONS: DS appeared as effective as UFH for anticoagulation in RDT. It can reliably be considered as an alternative approach especially in cases of thrombocytopenia or other adverse effects of UFH.


Assuntos
Anticoagulantes/administração & dosagem , Dermatan Sulfato/administração & dosagem , Heparina/administração & dosagem , Diálise Renal/métodos , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Coagulação Sanguínea/efeitos dos fármacos , Intervalos de Confiança , Dermatan Sulfato/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Heparina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Tempo de Tromboplastina Parcial , Contagem de Plaquetas , Diálise Renal/efeitos adversos , Estudos Retrospectivos
2.
Bone ; 51(3): 332-7, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22699014

RESUMO

BACKGROUND: Patients on dialysis may have abnormal serum levels of Ca, P and parathyroid hormone, with related bone diseases. This population has an increased risk of death, with cardiovascular calcification (CC) a contributing factor. Patients on peritoneal dialysis appear to be at increased risk of hyperlipidemia, a contributing factor to atherosclerotic plaque formation. Although several studies have described the presence and progression of CC in hemodialysis populations, there are fewer data in patients on peritoneal dialysis. STUDY DESIGN: The Renal Osteodystrophy and Calcifications: Key factors in Peritoneal Dialysis (ROCK-PD) study was a 36-month, prospective observational study conducted in Italy. The study examined the presence and progression of CC in two cardiac valves and five arterial sites. The potential associations of serum Ca and P with mortality and cardiovascular morbidity, demographic, clinical and blood chemistry variables was investigated. RESULTS: CC was present in 77% of patients at baseline (N=369) and in 90% of patients by study end (N=145), progressing in 73% of patients. There were 42 deaths (11%). Analyses showed a marked correlation between baseline P levels and the presence of left ventricular hypertrophy. However, there were no consistent correlations between serum Ca or P with mortality or morbidity. CONCLUSIONS: CC was common in peritoneal dialysis patients and progressed in a majority of patients.


Assuntos
Calcinose/epidemiologia , Calcinose/etiologia , Cardiomiopatias/epidemiologia , Cardiomiopatias/etiologia , Progressão da Doença , Diálise Peritoneal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Calcinose/sangue , Calcinose/patologia , Cálcio/sangue , Cardiomiopatias/mortalidade , Cardiomiopatias/patologia , Demografia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/sangue , Hipertrofia Ventricular Esquerda/complicações , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fósforo/sangue , Prevalência , Estudos Prospectivos , Análise de Sobrevida , Adulto Jovem
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