[Hemoglobin levels and probability of better quality of life in chronic hemodialysis patients]. / Niveles de hemoglobina y probabilidad de mejor calidad de vida en hemodializados crónicos.

Hemoglobin is one of the health quality of life predictors in chronic hemodialysis patients. We were interested in knowing whether high or normal levels of hemoglobin corresponded to better quality of life and where it could be find the threshold value from which the odds of improvement would be significatively different. There were studied, transversal and retrospectively, 87 patients (38 females) in chronic hemodialysis (ages: 54 +/- 23 years--time in HD treatment 52.30 +/- 56.40 months--kt/vsp: 1.30 +/- 0.12, TACu: 94 +/- 93 mg/dl and PCR: 1.05 +/- 0.33 g/kw/d. They were gathered in G1: X Hb: 8.70 +/- 1.06 g/dl, G2: X Hb: 10.55 +/- 0.40 g/dl y G3 X Hb: 11.92 +/- 0.66 g/dl and were measured the eight SF-36 domains. There were founded significative differences among the G1 and G2 scores in general health, vitality and social functioning (table II). The hemoglobin was predictors of general health as to vitality and both showed as direct relationship. The odds differences in a better quality of life (table III) were seen in general health and vitality, respectively, and with 13.5 g/dl or more, there++ were no statistically significative differences.

Niveles de hemoglobina y probabilidad de mejor calidad de vida en hemodializados crónicos / Hemoglobin levels and odds of better quality of life in chronic hemodialysis patients

La hemoglobina es uno de los predictores de calidad de vida en los hemodializados crónicos. Nos interesó conocer si a niveles elevados y/o normales de hemoglobina, le correspondía mejor calidad de vida y dónde se ubicaría el valor umbral a partir del cual las probabilidades de mejoría fueran significativamente diferentes. Se estudiaron transversal y retrospectivamente 87 pacientes (38 de sexo femenino) en hemodiálisis crónica (edades: 54 ñ 23 años -antigüedad en el tratamiento: 52,30 ñ 56,40 meses KTVsp: 1,30 ñ 0,12; TACu: 94 ñ 93 mg/dl y PCR: 1,05 ñ 0,33 g/kg/día). Se agruparon en: G,: X Hb: 8,70 ñ 1,06 g/dl, G2: X Hb: 10,55 ñ 0,40 g/dl y G3 X Hb: 12,92 ñ 0,66 g/dl y midieron los 8 dominios de SF-36.Se hallaron diferencias significativas entre las puntuaciones de G, y G2 en salud general, vitalidad y función social. La hemoglobina fue predictora para salud general y vitalidad, y ambas mostraron una relación directa. Las diferencias en las probabilidades de mejor calidad de vida se vieron con hemoglobinas de 12 g/dl y 11,7 g/dl para salud general y vitalidad, respectivamente y con 13,5 g/dl o más, no hubo cambios clínicos o estadísticos de importancia (AU)

[The equivalent renal urea clearance. Its relationship with mortality in chronic hemodialysed patients]. / Equivalente del clearance renal de urea. Su relación con la mortalidad en hemodializados crónicos.

The Equivalent Renal Urea Clearance (EKR) integrates the residual renal function (KR) and the dialysis dose (Kt/V). The present study was performed with these objectives: to calculate EKR in our hemodialysis (HD) patients during a three year follow up, to define its relationship with mortality and to compare its importance as a risk factor among others and to calculate actuarial survival. We analyzed 267 chronic HD patients. We measured Kt/V single pool, TACu, albumin, creatinine, hemoglobin and HD time and we calculated KR, EKR, KRc and EKRc (the last two corrected for V* 401--to compare clearances of different size patients). The EKRc median was 14.20 ml/min and it was taken as cut off point. The mortality OR was 2.17. The multivariated analysis showed, as independent mortality predictors, the albumin (the most significant), the EKRc and the HD time. The actuarial survival of EKRc, Kt/V and albumin showed marked similarity of their curves. The significant differences between the predictor curves began on the 2nd year of HD, for albumin they began in levels lesser than 3.5 g/dl and higher than 3.4 g/dl. Therefore, we consider that the best advantage of EKRc, compared to other parameters derived from the urea kinetics model, was the possibility to valuate the weekly HD adequation (once, twice or three times a week) and this, depending on the KR and the Kt/V of each HD treatment. Besides, the EKRc could also be used as adequacy criterion in CAPD considering daily Kt/V so that we could employ EKRc as adequacy parameter for both replacement therapies.

Equivalente del clearance renal de urea. Su relación con la mortalidad en hemodializados crónicos. / [The equivalent renal urea clearance. Its relationship with mortality in chronic hemodialysed patients]

The Equivalent Renal Urea Clearance (EKR) integrates the residual renal function (KR) and the dialysis dose (Kt/V). The present study was performed with these objectives: to calculate EKR in our hemodialysis (HD) patients during a three year follow up, to define its relationship with mortality and to compare its importance as a risk factor among others and to calculate actuarial survival. We analyzed 267 chronic HD patients. We measured Kt/V single pool, TACu, albumin, creatinine, hemoglobin and HD time and we calculated KR, EKR, KRc and EKRc (the last two corrected for V* 401--to compare clearances of different size patients). The EKRc median was 14.20 ml/min and it was taken as cut off point. The mortality OR was 2.17. The multivariated analysis showed, as independent mortality predictors, the albumin (the most significant), the EKRc and the HD time. The actuarial survival of EKRc, Kt/V and albumin showed marked similarity of their curves. The significant differences between the predictor curves began on the 2nd year of HD, for albumin they began in levels lesser than 3.5 g/dl and higher than 3.4 g/dl. Therefore, we consider that the best advantage of EKRc, compared to other parameters derived from the urea kinetics model, was the possibility to valuate the weekly HD adequation (once, twice or three times a week) and this, depending on the KR and the Kt/V of each HD treatment. Besides, the EKRc could also be used as adequacy criterion in CAPD considering daily Kt/V so that we could employ EKRc as adequacy parameter for both replacement therapies.

[Medical parathyroidectomy. Its efficacy in treatment of lower maxillary brown tumor]. / Paratiroidectomía médica. Su eficacia en el tratamiento de un tumor pardo en el maxilar inferior.

A patient with end-stage renal disease, hemodialysis treatment, severe secondary hyperparathyroidism and mandibular brown tumor received increasing doses of oral calcitriol (3.5 to 9 micrograms/week) and calcium carbonate (10 g/day). Nineteen months after the treatment, clinical, radiological and humoral improvement were observed. The present case demonstrates the effectiveness of medical parathyroidectomy for the control of severe secondary hyperparathyroidism--brown tumor--in chronic hemodialysed patients. This procedure should be considered as choice treatment keeping surgical parathyroidectomy for cases in which it is contraindicated such as hyperphosphoremia and/or controlled hypercalcemia or failure of the former procedure.

[Rapid correction of acute hyperkalemia with nebulized salbutamol]. / Corrección rápida de la hiperkalemia aguda con salbutamol en nebulización.

Fifteen patients on chronic hemodialysis received twenty-two treatments with 20 mg nebulized salbutamol (4 ml of 0.6 g% in 4 ml of saline), to control an episode of acute hyperkalemia, (6.58 +/- 0.14 range: 5.7-7.9 mEq/l) and as a previous step before dialysis. Plasma potassium concentration at 20, 40, 60, 90 and 180 min post-salbutamol, were: 5.85 +/- 0.21, 5.58 +/- 0.21, 5.48 +/- 0.27, 5.46 +/- 0.17 and 5.57 +/- 0.34 mEq/l, respectively. (Fig. 1). The decrease of plasma potassium was significant at 40' and maximal at 90': 1.12 +/- 0.10 mEq/l, and persisted for at least 3 hours (in 3 patients up to 6 hours). No correlation was found between the grade of hyperkalemia and the magnitude of plasma potassium decrease after therapy. The systolic and diastolic blood pressure decreased significantly at 60 and 80 min post-treatment: 134 +/- 6.45 vs 119 +/- 6.79 and 74 +/- 4.12 vs 64.66 +/- 3.88 mmHg (p < 0.02 and p < 0.001). The heart rate and respiratory frequency increased significantly at 60-80 and 20 min respectively (90 +/- 4.45 vs 113 +/- 4.55 beats/min and 19.57 +/- 0.98 vs 23.42 +/- 1.24 resp/min) (p < 0.001) (Table 1). The secondary effects of the administration of the drug, such as sinus tachycardia, fine tremor and anxiety in 6, 4 and 1 patient respectively, were moderate and well tolerated. It is concluded that, due to its technical feasibility, promptness of action, duration of hypokalemic effect, few side effects and repeatability, nebulized salbutamol can be considered a first choice in the treatment of acute hyperkalemia.

Correccion rapida de la hiperkalemia aguda con salbutamol en nebulizacion / Rapid correction of acute hyperkalemia with nebulized salbutamol

En 15 pacientes en hemodiálise crónica y con hiperkalemia aguda, se relizaron 22 tratamientos con 20 mg de salbutamol en nebulización, para descender la potasemia, hasta que se pudiera efectuar la hemodiálisis. Los controles de laboratorio realizados a los 20, 40, 60, 90 y 180 minutos, revelaron que los descensos de los niveles de potasio en plasma fueron significativos a los 40 minutos, máximos a los 90 minutos (1,12 ñ 0,10 mEql) y persistieron descendidos hasta por lo menos 3 horas (en 3 casos hasta 6 horas), luego del tratamiento. Alcanzó significación el descenso de la tensión arterial sistólica y diastólica, y el incremento en las frecuencias cardíacas y respiratoria. Esta modalidad terapéutica fue efectiva en todos los casos en que se la realizó. Los efectos secundarios a la administración de la droga fueron moderados y tolerables: taquicardia sinusal, temblor fino y sensación de ansiedad, en 6,4 y 1 pacientes, respectivamente (AU)

Correccion rapida de la hiperkalemia aguda con salbutamol en nebulizacion / Rapid correction of acute hyperkalemia with nebulized salbutamol

En 15 pacientes en hemodiálise crónica y con hiperkalemia aguda, se relizaron 22 tratamientos con 20 mg de salbutamol en nebulización, para descender la potasemia, hasta que se pudiera efectuar la hemodiálisis. Los controles de laboratorio realizados a los 20, 40, 60, 90 y 180 minutos, revelaron que los descensos de los niveles de potasio en plasma fueron significativos a los 40 minutos, máximos a los 90 minutos (1,12 ñ 0,10 mEql) y persistieron descendidos hasta por lo menos 3 horas (en 3 casos hasta 6 horas), luego del tratamiento. Alcanzó significación el descenso de la tensión arterial sistólica y diastólica, y el incremento en las frecuencias cardíacas y respiratoria. Esta modalidad terapéutica fue efectiva en todos los casos en que se la realizó. Los efectos secundarios a la administración de la droga fueron moderados y tolerables: taquicardia sinusal, temblor fino y sensación de ansiedad, en 6,4 y 1 pacientes, respectivamente

Corrección rápida de la hiperkalemia aguda con salbutamol en nebulización. / [Rapid correction of acute hyperkalemia with nebulized salbutamol]

Fifteen patients on chronic hemodialysis received twenty-two treatments with 20 mg nebulized salbutamol (4 ml of 0.6 g

in 4 ml of saline), to control an episode of acute hyperkalemia, (6.58 +/- 0.14 range: 5.7-7.9 mEq/l) and as a previous step before dialysis. Plasma potassium concentration at 20, 40, 60, 90 and 180 min post-salbutamol, were: 5.85 +/- 0.21, 5.58 +/- 0.21, 5.48 +/- 0.27, 5.46 +/- 0.17 and 5.57 +/- 0.34 mEq/l, respectively. (Fig. 1). The decrease of plasma potassium was significant at 40 and maximal at 90: 1.12 +/- 0.10 mEq/l, and persisted for at least 3 hours (in 3 patients up to 6 hours). No correlation was found between the grade of hyperkalemia and the magnitude of plasma potassium decrease after therapy. The systolic and diastolic blood pressure decreased significantly at 60 and 80 min post-treatment: 134 +/- 6.45 vs 119 +/- 6.79 and 74 +/- 4.12 vs 64.66 +/- 3.88 mmHg (p < 0.02 and p < 0.001). The heart rate and respiratory frequency increased significantly at 60-80 and 20 min respectively (90 +/- 4.45 vs 113 +/- 4.55 beats/min and 19.57 +/- 0.98 vs 23.42 +/- 1.24 resp/min) (p < 0.001) (Table 1). The secondary effects of the administration of the drug, such as sinus tachycardia, fine tremor and anxiety in 6, 4 and 1 patient respectively, were moderate and well tolerated. It is concluded that, due to its technical feasibility, promptness of action, duration of hypokalemic effect, few side effects and repeatability, nebulized salbutamol can be considered a first choice in the treatment of acute hyperkalemia.

Corrección rápida de la hiperkalemia aguda con salbutamol en nebulización. / [Rapid correction of acute hyperkalemia with nebulized salbutamol]

Fifteen patients on chronic hemodialysis received twenty-two treatments with 20 mg nebulized salbutamol (4 ml of 0.6 g

in 4 ml of saline), to control an episode of acute hyperkalemia, (6.58 +/- 0.14 range: 5.7-7.9 mEq/l) and as a previous step before dialysis. Plasma potassium concentration at 20, 40, 60, 90 and 180 min post-salbutamol, were: 5.85 +/- 0.21, 5.58 +/- 0.21, 5.48 +/- 0.27, 5.46 +/- 0.17 and 5.57 +/- 0.34 mEq/l, respectively. (Fig. 1). The decrease of plasma potassium was significant at 40 and maximal at 90: 1.12 +/- 0.10 mEq/l, and persisted for at least 3 hours (in 3 patients up to 6 hours). No correlation was found between the grade of hyperkalemia and the magnitude of plasma potassium decrease after therapy. The systolic and diastolic blood pressure decreased significantly at 60 and 80 min post-treatment: 134 +/- 6.45 vs 119 +/- 6.79 and 74 +/- 4.12 vs 64.66 +/- 3.88 mmHg (p < 0.02 and p < 0.001). The heart rate and respiratory frequency increased significantly at 60-80 and 20 min respectively (90 +/- 4.45 vs 113 +/- 4.55 beats/min and 19.57 +/- 0.98 vs 23.42 +/- 1.24 resp/min) (p < 0.001) (Table 1). The secondary effects of the administration of the drug, such as sinus tachycardia, fine tremor and anxiety in 6, 4 and 1 patient respectively, were moderate and well tolerated. It is concluded that, due to its technical feasibility, promptness of action, duration of hypokalemic effect, few side effects and repeatability, nebulized salbutamol can be considered a first choice in the treatment of acute hyperkalemia.