[Study of immutable variables determining rHuEPO dose requirements on hemodialysis patients]. / Estudio de causas no modificables de pobre respuesta al tratamiento con eritropoyetina en pacientes en hemodiálisis.

Patients receiving recombinant human erythropoietin (rHuEPO) therapy show wide variability in their responsiveness to the drug. Variables that affect rHuEPO dose requirements can be broadly divided into modificable and immutable characteristics. Most of the scientific research on rHuEPO hyporesponsiveness has focused on modificable variables (iron status, dialysis adequacy), while immutable variables such as gender, etiology of chronic renal failure (CRF) and age have been insufficiently explored. A cross sectional study was performed in order to evaluate if immutable patient characteristics determine rHuEPO dose requirements among 215 patients (52% males; mean age 66 +/- 14 years) on hemodialysis (HD) for more than twelve months. Data were collected at 10 hemodialysis units in Aragon. Patients were divided into three groups according to their gender, their cause of CRF (diabetic nephropathy, vascular nephropathy, tubulointerstitial nephropathy and primary glomerulonephritis) and their age (younger than 60 years, from 60 to 75 years, older than 75 years). Despite a similar dose of rHuEPO, women had lower mean hemoglobin (11.1 +/- 1.5 versus 11.6 +/- 1.7 g/dl; p = 0.0258) than men. The greater hemoglobin in men than women may be attributed to greater serum albumin in men (3.5 +/- 0.3 versus 3.7 +/- 0.3 mg/dl; p = 0.0001). Requirements of rHuEPO were higher in the patients with etiology of primary glomerulonephritis compared with those with the other etiologies, even those with diabetic nephropathy (p = 0.0374). The rHuE-PO doses required to obtain similar hemoglobin levels were higher in patients younger than 60 years (p = 0.0249). We conclude that women, patients with primary glomerulonephritis as cause of CRF, and patients younger than 60 years showed the highest requirements of rHuEPO doses.

[Diabetes in hemodialysis: study of differential factors]. / Diabetes en hemodiálisis: estudio de factores diferenciales.

OBJECTIVES: In uremic patients with diabetes mellitus, morbi-mortality on maintenance hemodialysis is considerably higher than in nondiabetic patients. This is mainly due to age, seniority and quality of the hemodialysis therapy, nutritional status, plasmatic lipid levels and associated pathology. We compare all these factors in the uremic patients under hemodialysis in diabetics and non-diabetics. METHODS: We have studied 307 uremic patients under hemodialysis therapy during 199 and 1996. Sixty of them had been diagnosticated of diabetes mellitus (19.6%), 17 were type I (DM-I) and 27 were type II (DM-II). We selected two control groups no-diabetics, one for each subgroup of diabetics with similar characteristics in age, sex and hemodialysis seniority. The control group for DM-I were 34 patients and for DM-II were 54 patients. RESULTS: Ideal body weight percentage, body mass index, mid-arm muscle circumference percentil, serum albumin and prealbumin are subnormal for DM-I. By considering whole nutritional date, a moderate to severe malnutrition was observed in 79% of DM-I patients, 50.4% of all non diabetics and only in 30.6% of patients included in the DM-II group. However, DM-II patients present hypertrigliceridemia and a decrease in HDL cholesterol and apolipoprotein A levels with a high atherogenic index. Significantly higher rates of associated pathology were observed among both types of diabetic patients than their control groups and especially referred to cardiovascular and neurological diseases. CONCLUSIONS: In conclusion, diabetes mellitus is an increasing incidence pathology in hemodialysis programs, that is associated to a higher morbi-mortality because vascular disease. Undernutrition is the main factor in DM-II whereas hyperlipidemia is in DM-II.

[Surgical complications in kidney transplantation. Analysis of our series (300 transplantations, 1986-1995)]. / Complicaciones quirúrgicas en el trasplante renal. Análisis de nuestra serie (300 trasplantes, 1986-1995).

OBJECTIVES: To review our series of 300 renal transplants, with special reference to the surgical complications and their management. METHODS: From June, 1986 to August, 1995, we performed 300 heterotopic renal transplants harvested from cadavers. Reconstruction of the urinary tract was by ureteroneocystostomy in practically all of the cases. RESULTS: The overall surgical complication rate was 20.3%. The graft was lost in 2 cases (0.66%). The most common urological complication was obstruction of the urinary tract arising from stenosis (3.6%), lymphocele (5.3%) and clotting (1.6%); 78.1% of these obstructive complications were resolved by endourological techniques. Urinary fistula was observed in 9 cases (3%) and lymphocele in 16 (5.3%), which were resolved by percutaneous drainage and sclerotherapy in 81.2% of the cases. Vascular complications were observed in 14 cases (4.6%), lithiasis in 5 (1.66%) and eventration in 6 (2%). The treatment of these complications are described. The actuarial graft and patient survival rates were 90.9% and 84.7% at one and five years, respectively, for the graft and 93.5% and 89% for the patients. CONCLUSIONS: Our surgical complication rate in patients undergoing renal transplantation was 20.3%. The most common complication was urinary tract obstruction from stenosis (3.6%), lymphocele (5.3%) and clotting (1.6%); 78.1% of these obstructive complications were resolved by endourological techniques. Percutaneous drainage of the lymphocele combined with sclerotherapy achieved resolution in 81.2%. Renal biopsy performed with a 14 G needle caused 5 severe hemorrhagic complications. There were no complications when an 18 G needle was utilized.

[Renal transplantation: results]. / Trasplante renal: resultados.

Between June 1986 and December 1991, 125 kidneys were transplanted in our hospital. Survival results of patients per annum was 94%, 90% of which represent grafts. Regarding the complications occurred in our series the most frequent ones were medical followed by surgical [urological (4%), vascular (2.4%) and others derived from the surgical procedure (20%)]. It was necessary to perform 5 transplantectomies.