Influencia de la sobrecarga de calcio sobre el metabolismo óseo y mineral en 55 centros de hemodiálisis de Lima / Impact of calcium overload on bone and mineral metabolism at 55 hemodialysis centers in Lima

ANTECEDENTES: Las alteraciones del metabolismo óseo y mineral son complicaciones frecuentes de los pacientes de hemodiálisis que presentan una gran variabilidad geográfica. OBJETIVOS: El objetivo del presente estudio fue evaluar por primera vez dichas alteraciones en pacientes de hemodiálisis de Perú. MÉTODOS: El estudio incluyó 1.551 pacientes de hemodiálisis de 55 centros concertados con el seguro social de salud de Perú, pertenecientes a la ciudad de Lima. De cada paciente se recogieron datos demográficos, comorbilidades, tratamientos y parámetros bioquímicos. Los valores de calcio, fósforo y PTH fueron categorizados según los rangos recomendados en las guías KDOQI y KDIGO. RESULTADOS: La edad media de los pacientes fue de 59,5 ± 15,6, con tiempo medio en hemodiálisis de 58,0 ± 54,2 meses. Todos los pacientes se dializaban con una concentración de calcio en el líquido de diálisis de 3,5 mEq/l y el 68,9% recibían captores de fósforo (98,4% carbonato de calcio). Se observó un alto porcentaje de pacientes con calcio sérico por encima y fósforo sérico por debajo de los rangos recomendados en las guías KDOQI (32,8% y 37,3% respectivamente). Más de la mitad de los pacientes tenían valores de PTH por debajo de los rangos recomendados, tanto en KDOQI como en KDIGO (56,4% y 51,6% respectivamente). CONCLUSIONES: Los pacientes incluidos en el presente estudio se caracterizaron por ser más jóvenes que los de otros estudios y por tener hipofosforemia y PTH suprimida, probablemente debido a una excesiva sobrecarga de calcio a través del líquido de diálisis y el empleo de captores de fósforo con calcio

BACKGROUND: Mineral and bone metabolism disorders are common complications in haemodialysis patients that present significant geographical variability. OBJECTIVES: The objective of this study was to assess these disorders for the first time in haemodialysis patients from Peru. METHODS: The study included 1551 haemodialysis patients from 55 centres affiliated with the Social Health System of Peru in the city of Lima. Demographic data, comorbidities, treatments and biochemical parameters were collected from each patient. Serum calcium, phosphorus and PTH levels were categorised according to the recommended ranges in the KDOQI and KDIGO guidelines. RESULTS: The mean age of the patients was 59.5 ± 15.6 years, with a mean time on haemodialysis of 58.0 ± 54.2 months. All patients were dialysed with a calcium concentration in the dialysis fluid of 3.5 mEq/l and 68.9% of patients were prescribed phosphate-binding agents (98.4% of them calcium carbonate). A high percentage of patients showed serum calcium above, and serum phosphorus below, the recommended ranges in the KDOQI guidelines (32.8% and 37.3%, respectively). More than half of the patients had serum PTH values below the recommended ranges of both the KDOQI and KDIGO guidelines (56.4% and 51.6%, respectively). CONCLUSIONS: Patients included in this study were younger than those from other studies and showed both hypophosphataemia and suppressed PTH, probably due to an excessive calcium overload through dialysis fluid and the use of calcium-containing phosphate binding agents

Bone and mineral metabolism at 55 haemodialysis centres in Lima. / Influencia de la sobrecarga de calcio sobre el metabolismo óseo y mineral en 55 centros de hemodiálisis de Lima.

BACKGROUND: Mineral and bone metabolism disorders are common complications in haemodialysis patients that present significant geographical variability. OBJECTIVES: The objective of this study was to assess these disorders for the first time in haemodialysis patients from Peru. METHODS: The study included 1551 haemodialysis patients from 55 centres affiliated with the Social Health System of Peru in the city of Lima. Demographic data, comorbidities, treatments and biochemical parameters were collected from each patient. Serum calcium, phosphorus and PTH levels were categorised according to the recommended ranges in the KDOQI and KDIGO guidelines. RESULTS: The mean age of the patients was 59.5±15.6 years, with a mean time on haemodialysis of 58.0±54.2 months. All patients were dialysed with a calcium concentration in the dialysis fluid of 3.5 mEq/l and 68.9% of patients were prescribed phosphate-binding agents (98.4% of them calcium carbonate). A high percentage of patients showed serum calcium above, and serum phosphorus below, the recommended ranges in the KDOQI guidelines (32.8% and 37.3%, respectively). More than half of the patients had serum PTH values below the recommended ranges of both the KDOQI and KDIGO guidelines (56.4% and 51.6%, respectively). CONCLUSIONS: Patients included in this study were younger than those from other studies and showed both hypophosphataemia and suppressed PTH, probably due to an excessive calcium overload through dialysis fluid and the use of calcium-containing phosphate binding agents.

Infección del tracto urinario en receptores de trasplante renal / Urinary tract infection in renal transplant recipients

Introducción. La infección del tracto urinario (ITU) es común en receptores de trasplante renal (TR). La frecuencia de ITU depende de factores previos y posteriores al trasplante. Objetivos. Determinar la cronología de aparición de ITU sintomática, los microorganismos causantes y la incidencia de ITU resistente a antibióticos en receptores de TR. Diseño. Estudio retrospectivo. Lugar. Unidad de Trasplante Renal, Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Participantes. Pacientes sometidos a TR. Intervenciones. Se revisó la historia clínica de 304 pacientes sometidos a TR en el período 2002-2011, con seguimiento de hasta cuatro años por paciente. Se constató 215 episodios de ITU sintomática confirmada mediante urocultivo en 84 receptores. Principales medidas de resultados. Incidencia, cronología, determinación microbiológica/susceptibilidad, resistencia bacteriana, factores de riesgo, estrategias diagnósticas, presencia o no de bacteriemia y manejo terapéutico. Resultados. En 50% de los 84 receptores el episodio inicial ocurrió durante los primeros tres meses, y en 39% se constató más de un episodio de ITU. Las bacterias representaron la etiología más frecuente (94%), siendo la Escherichia coli (77%) el uropatógeno prevalente, con tasa productora betalactamasa espectro extendido (BLEE) en 38%, seguida de Klebsiella pneumonie (11%) con BLEE 65%. En 12% de los 215 episodios de ITU el hemocultivo fue positivo. Entre los factores de riesgo se detectó luego del trasplante 19% receptores con anormalidades anatómicas del tracto urinario. Conclusiones. La ITU ocurrió tempranamente luego del trasplante y la Escherichia coli fue el microorganismo etiológico más frecuente. La resistencia antibiótica estuvo presente en 37% de los 215 episodios de ITU, representando un desafío contínuo a resolver en la práctica clínica.

Introduction. Urinary tract infections (UTI) are common among renal transplant recipients (RTR) and their frequency depends on pre- and post-transplant factors. Objectives. To determine the time of appearance of symptomatic UTI among renal transplant recipients, microorganisms causing the infection, and incidence of UTI resistant to antibiotics. Design. Retrospective study. Setting. Renal Transplant Unit, Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Peru. Participants. Patients who have undergone renal transplantation. Interventions. The clinical records of 304 patients subject to kidney transplantation performed between 2002 and 2011 and followed for up to four years were reviewed. There were 215 urine culture-confirmed UTI episodes in 84 transplant recipients. Main outcome measures. Incidence, chronology, microbiological determination/ susceptibility, bacterial resistance, risk factors, diagnostic strategies, presence or absence of bacteremia, and therapeutic management. Results. In 42 of the 84 recipients, the initial episode occurred during the first three months, and 33 (39%) had more than one UTI episode. Bacteria represented the most common etiology (94%), and Escherichia coli was the most prevalent uropathogen, with an extended-spectrum beta-lactamase (ESBL) production rate of 38%, followed by Klebsiella pneumoniae (11%) with an ESBL of 65%. Blood culture was positive in 25 (12%) of the 215 UTI episodes. In 17 recipients (19%), anatomic anomalies of the urinary tract were detected following the transplant. Conclusions. UTI occurred early following kidney transplantation, and Escherichia coli was the most common microorganism found. Antibiotic resistance was present in 79 (37%) of the 215 UTI episodes, representing a continuous challenge in clinical practice.