[Prognostic significance of hemoperitoneum in peritoneal dialysis]. / Significado pronóstico del hemoperitoneo en diálisis peritoneal.

According to previous reviews, hemoperitoneum episodes appear in 6.1-8.4% of the peritoneal dialysis patients, and they are severe in a 20% of them. Due to the absence of severe hemoperitoneum in our peritoneal dialysis program, we retrospectively reviewed hemoperitoneum non-related with abdominal surgery or catheter placing. We analyzed its incidence, etiology, prognostic and clinical outcome, as well as the possible effect of recurrent hemoperitoneum on peritoneal function. A total of 132 patients were treated in our centre during a period of 173 months. Mean age at the beginning of peritoneal dialysis was 59+/-17.1 years, 43.2% were females, and 22.8% of them were menstruating women. Twenty-two patients had at least one hemoperitoneum episode during follow-up, with an incidence of 17%. The mean time interval between the start of peritoneal dialysis and the first hemoperitoneum episode was 0.66+/-0.94 years (range: 0.01-3.20 years). 73% were women. Most cases (59%) were due to menstruation. Remarkably, all the menstruating women presented hemoperitoneum at least once with a high incidence of recurrent episodes. The other hemoperitoneum episodes were mainly of unknown etiology (32% of patients), being this one the main cause in males. We only observed two more cases: a male who presented hemoperitoneum related to dicumarinic overdose and a female who presented hemoperitoneum due to mesenteric ischemia. All the 22 patients had a favourable outcome, except for the woman with mesenteric ischemia, what represented an incidence of 4.5% of severe hemoperitoneum. No significant association was found between episodes of hemoperitoneum and aspirin treatment, dicumarinic treatment or the presence of coagulopathy. There was no association either between recurrent hemoperitoneum and the number of peritonitis episodes, peritoneal function or technique survival. In conclusion, hemoperitoneum is a common and usually benign problem in peritoneal dialysis patients, frequently due to retrograde menstruation, and no deleterious long-term effects were found in patients with recurrent hemoperitoneum.

Significado pronóstico del hemoperitoneo en diálisis peritoneal / Prognostic significance of hemoperitoneum in peritoneal dialysis

Según revisiones previas, entre el 6,1 y el 8,4% de los pacientes en diálisis peritoneal presentan episodios de hemoperitoneo y su pronóstico es grave hasta en un 20% de casos. Ante la ausencia de hemoperitoneos graves en nuestro programa de diálisis peritoneal, decidimos revisar retrospectivamente los hemoperitoneos no relacionados con la cirugía abdominal ni con la colocación del catéter. Analizamos su incidencia, etiología, pronóstico y evolución, así como el efecto del hemoperitoneo recurrente sobre la función peritoneal en 132 pacientes con edad media al iniciar diálisis peritoneal de 59 ± 17,1 años, de los que el 43,2% eran mujeres y, de éstas, un 22,8% tenían la menstruación. Durante el seguimiento, 22 pacientes tuvieron al menos un episodio de hemoperitoneo, con una incidencia del 17% y un tiempo medio en diálisis peritoneal hasta el primer episodio de hemoperitoneo de 0,66 ± 0,94años (rango: 0,01-3,20 años). El 73% eran mujeres. La menstruación fue la causa del 59% de los hemoperitoneos. El 32% fueron de etiología desconocida, siendo ésta la causa más frecuente en varones. Únicamente un varón presentó hemoperitoneo en relación a sobredosis de dicumarínicos y una mujer presentó hemoperitoneo secundario a una isquemia intestinal. La evolución fue favorable en todos ellos a excepción de la paciente con isquemia mesentérica, lo que supuso una incidencia de hemoperitoneos graves del 4,5%. El tratamiento antiagregante o anticoagulante y la presencia de coagulopatía no se relacionaron con la aparición de hemoperitoneo. Tampoco hubo relación entre el hemoperitoneo recurrente y el número de peritonitis, el deterioro de la función peritoneal y la supervivencia de la técnica. En conclusión, el hemoperitoneo es un problema frecuente en diálisis peritoneal y generalmente benigno, a menudo asociado a la menstruación, y sin efectos negativos a largo plazo en los pacientes con hemoperitoneo recurrente (AU)

According to previous reviews, hemoperitoneum episodes appear in 6.1-8.4% of the peritoneal dialysis patients, and they are severe in a 20% of them. Due to the absence of severe hemoperitoneum in our peritoneal dialysis program, we retrospectively reviewed hemoperitoneum non-related with abdominal surgery or catheter placing. We analyzed its incidence, etiology, prognostic and clinical outcome, as well as the possible effect of recurrent hemoperitoneum on peritoneal function. A total of 132 patients were treated in our centre during a period of 173 months. Mean age at the beginning of peritoneal dialysis was 59 ± 17.1 years, 43.2% were females, and 22.8% of them were menstruating women. Twentytwo patients had at least one hemoperitoneum episode during follow-up, with an incidence of 17%. The mean time interval between the start of peritoneal dialysis and the first hemoperitoneum episode was 0,66 ± 0,94 years (range: 0.01-3.20 years). 73% were women. Most cases (59%) were due to menstruation. Remarkably, all the menstruating women presented hemoperitoneum at least once with a high incidence of recurrent episodes. The other hemoperitoneum episodes were mainly of unknown etiology (32% of patients), being this one the main cause in males. We only observed two more cases: a male who presented hemoperitoneum related to dicumarinic overdose and a female who presented hemoperitoneum due to mesenteric ischemia. All the 22 patients had a favourable outcome, except for the woman with mesenteric ischemia, what represented an incidence of 4.5% of severe hemoperitoneum. No significant association was found between episodes of hemoperitoneum and aspirin treatment, dicumarinic treatment or the presence of coagulopathy. There was no association either between recurrent hemoperitoneum and the number of peritonitis episodes, peritoneal function or technique survival. In conclusion, hemoperitoneum is a common and usually benign problem in peritoneal dialysis patients, frequently due to retrograde menstruation, and no deleterious long-term effects were found in patients with recurrent hemoperitoneum (AU)

[Choosing not to dialysis in chronic renal failure in stage V (Renal Failure). Evolution of the characteristics of patients between 1992-1995 and 2000-2003]. / Elección de no diálisis en insuficiencia renal crónica en estadio V (fallo renal). Evolución de las características de los pacientes entre 1992-1995 y 2000-2003.

BACKGROUND: The incidence of chronic renal failure increase with the age. The selection of patient to dialysis has been increasing in spite of the high comorbidity. Moreover, in our clinical practice the aged patient is not contraindicated to dialysis. However, in the nephrology clinical practice not all the patients start the treatment with dialysis. OBJECTIVE The aim of our study has been to compare the characteristics of the patients who had not been dialyzed between the periods 1992-1995 and 2000-2003 to analyze the trend of the nephrology clinical practice. MATERIAL AND METHODS: Comparative study of the characteristics and the evolution of patients with chronic renal failure in stage V, (renal failure) not incorporated to dialysis in one hospital during four years between the periods the 1992-1995 ( period A) and 2000-2003 (period B). RESULTS: Start dialysis (period A versus period B): 116 patients, age 59.9+15.5 years vs. 229 patients, age 64.0+15.8 years (p<0.05). Non-dialysis (period A versus period B): 38 patients, age 77.5+9.3 years vs. 37 patients, age 81.7+6.2 years (p<0.01). Renal function: serum creatinina 7.4+2.4 mg/dl vs. 5.3+1.2 mg/dl (p<0.001), MDRD estimate glomerular filtration 6.9+2.4 mg/dl ml/min/1.73 m2 vs. 10.0+2.3 ml/min/1.73 m2 (p<0.001). Primary renal disease: unknown etiology 31.5 % vs. 24.3 %, nephroangiosclerosis 23.6 % vs. 32.4 %, diabetes 28.9 % vs. 21.6 %. Functional status: dependent patients 34.2 % vs 83.8 % (p<0.001). The principal reason for non-dialysis were: personal decision: 26.3 % vs. 35.1 %, dementia 15.8 % vs. 29.7 %, brief life expectancy because of serious co-existing diseases 13.1 % vs. 21.7 % and serious chronic illness with inability for themselves care 44.7 % vs. 13.1 %. Comorbid conditions: 2.3+1.0 vs. 3.0+1.5 (p<0.05). Survival: 55+168 days vs. 168+236 days (p<0.001). CONCLUSION: Most of the patients that don't begin dialysis are elderly together with a poor functional capacity and with more autonomy in their decisions. The identification of patients with renal failure (stage V) was detected early in the last period than in the following one. The conservative management of non-dialyzed uremic patients is a significative nephrology clinical practice due to more survival of those persons.

[Secondary amyloidosis (AA-type) due to localized cutaneous vasculitis]. / Amiloidosis secundaria asociada a vasculitis cutánea localizada.

We report a case of a 49 year old man, diagnosed soon after the outcome of casual proteinuria, of AA-type amyloidosis in relation to small and medium vessel cutaneous vasculitis without systemic involvement. This combination is a rare entity and only two cases of cutaneous hypersensibility vasculitis complicated with AA-type amyloidosis had been reported. We describe the results of the use of several immunosuppressive drugs during four years follow up with temporally total remission of the disease.

Elección de no diálisis en insuficiencia renal crónica en estadio V (fallo renal). Evolución de las características de los pacientes entre 1992-1995 y 2000-2003 / Choosing not to dialysis in chronic renal failure in stage V (renal failure). Evolution of the characteristics of patients between 1992-1995 and 2000-2003

Introducción: La insuficiencia renal crónica (IRC) es una patología que aumenta su incidencia con la edad. La aceptación de pacientes para diálisis ha ido aumentando en los últimos años a pesar del incremento de la comorbilidad, no considerándose la edad como contraindicación para el tratamiento sustitutivo renal. No obstante, en la práctica clínica nefrológica hay pacientes que no son incluidos en diálisis. Objetivo: Comparar las características de los pacientes con IRC no incluidos en diálisis en los períodos 1992-1995 y 2000-2003 para analizar las tendencias evolutivas de la práctica clínica nefrológica. Material y método: Estudio comparativo de las características basales y la evolución de los pacientes con IRC en estadio de fallo renal (estadio V) en quienes se decidió la elección de No-Diálisis atendidos en un sólo hospital durante 4 años entre los períodos de 1992-1995 (período A) y 2000-2003 (período B). La elección de No-Diálisis fue por decisión del paciente si era autónomo o de sus representantes legales en caso contrario. Resultados: SI-Diálisis: (período A versus período B): n:116 pacientes, edad: 59,9 + 15,5 años vs n: 229 pacientes, edad: 64,0 + 15,8 años (p < 0,05). NO-Diálisis: (período A versus período B): n: 38 pacientes, 24,6% de la IRC que inició diálisis, edad: 77,5 + 9,3 años vs n: 37 pacientes, 13,9% de la IRC que inició diálisis, edad: 81,7 + 6,2 años (p < 0,01). Funcionalismo renal: creatinine sérica 7,4 + 2,4 mg/dl vs 5,3 + 1,2 mg/dl (p < 0,001); filtrado glomerular estimado por MDRD abreviado: 6,9 + 2,4 ml/min/1,73 m2 vs 10,0 + 2,3 ml/min/1,73 m2 (p < 0,001). Enfermedad renal primaria principales: etiologia no aclarada 31,5% vs 24,3%, nefroangiosclerosis 23,6% vs 32,4%, diabetes 28,9 vs 21,6. Los motivos principales de la elección de no diálisis fueron: decisión personal 26,3% vs 35,1%, incompetencia mental persistente 15,8% vs 29,7%, pronóstico mortal a corto plazo 13,1% vs 21,7% y deterioro crónico severo con incapacidad de cuidarse 44,7% vs 13,5%. Autonomia funcional: pacientes dependientes 34,2% vs 83,8% (p < 0,001). Comorbilidades: 2,3 + 1,0 vs 3,0 + 1,5 procesos (p < 0,05), insuficiencia cardíaca 36,8% vs 48,8%, enfermedad cerebro-vascular 47,3% vs 51,3%, artropatía invalidante 13,1% vs 43,2%. Supervivencia media 55 + 168 días vs 168 + 236 días (p < 0,001). Conclusión: Los pacientes que no inician diálisis en los últimos años son más viejos, tienen peor capacidad física y son más autónomos en su capacidad de decisión. La identificación de los pacientes con IRC en estadio V se hace de forma más precoz y el seguimiento es más prolongado en el último período. El manejo nefrológico conservador de la IRC estadio V es una práctica clínica nefrológica significativa debido a la mayor supervivencia de estos pacientes

Background: The incidence of chronic renal failure increase with the age. The selection of patient to dialysis has been increasing in spite of the high comorbidity. Moreover, in our clinical practice the aged patient is not contraindicated to dialysis. However, in the nephrology clinical practice not all the patients start the treatment with dialysis. Objective: The aim of our study has been to compare the characteristics of the patients who had not been dialyzed between the periods 1992-1995 and 2000- 2003 to analyze the trend of the nephrology clinical practice. Material and met- hods: Comparative study of the characteristics and the evolution of patients with chronic renal failure in stage V (renal failure) not incorpored to dialysis in one hospital during four years between the periods the 1992-1995 (period A) and 2000-2003 (period B). Results: Start dialysis (period A versus period B): 116 patients, age 59.9 + 15.5 years vs 229 patients, age 64.0 + 15.8 years (p < 0.05). Non-dialysis (period A versus period B): 38 patients, age 77.5 + 9.3 years vs 37 patients, age 81.7 + 6.2 years (p < 0.01). Renal function: serum creatinina 7.4 + 2.4 mg/dl vs 5.3 + 1.2 mg/dl (p < 0.001), MDRD estimate glomerular filtration 6.9 + 2.4 mg/dl ml/min/1.73 m2 vs 10.0 + 2.3 ml/min/1.73 m2 (p < 0.001). Primary renal disease: unknown etiology 31.5% vs 24.3%, nephroangiosclerosis 23.6% vs 32.4%, diabetes 28.9% vs 21.6%. Functional status: dependent patients 34.2% vs 83.8% (p < 0.001). The principal reason for non-dialysis were: personal decision: 26.3% vs 35.1%, dementia 15.8% vs 29.7%, brief life expectancy because of serious co-existing diseases 13.1% vs. 21.7% and serious chronic illness with inability for themselves care 44.7% vs 13.1%. Comorbid conditions: 2.3 + 1.0 vs 3.0 + 1.5 (p < 0.05). Survival: 55 + 168 days vs 168 + 236 days (p < 0.001). Conclusión: Most of the patients that don’t begin dialysis are elderly together with a poor functional capacity and with more autonomy in their decisions. The identification of patients with renal failure (stage V) was detected early in the last period than in the following one. The conservative management of non-dialyzed uremic patients is a significative nephrology clinical practice due to more survival of those persons

Amiloidosis secundaria asociada a vasculitis cutánea localizada / Secondary amyloidosis (AA-type) due to localized cutaneous vasculitis summary

Presentamos el caso de un paciente de 49 años de edad, diagnosticado a raíz del hallazgo de proteinuria aislada, de amiloidosis AA asociada a vasculitis de mediano y pequeño calibre con afectación exclusivamente cutánea. Esta asociación es muy poco frecuente y sólo se han descrito dos casos de vasculitis por hipersensibilidad y amiloidosis AA. Comentamos la evolución a lo largo de cuatro años en que ha sido tratado con distintos inmunosupresores, consiguiendo algún período de remisión completa de la enfermedad

We report a case of a 49 years old man, diagnosed soon after the outcome of casual proteinuria, of AA-type amyloidosis in relation to small and medium vessel cutaneous vasculitis without systemic involvement. This combination is a rare entity and only two cases of cutaneous hipersensiblility vasculitis complicated with AA-type amyloidosis had been reported. We describe the results of the use of several inmunossupressive drugs during four years follow up with temporally total remission of the disease

[Renal involvement in amyloidosis. Clinical outcomes, evolution and survival]. / Afectación renal en la amiloidosis. Características clínicas, evolución y supervivencia.

BACKGROUND: Systemic amyloidosis is a disease resulting from extracellular deposition of fibrillar protein in various organs. Main systemic amyloidosis are: primary (AL) and Secondary (AA). The kidney is usually involved, conferring and adverse prognosis. In the last decade there has been a change in the aetiology of AA amyloidosis. OBJECTIVES: To analyse the incidence of AL and AA amyloidosis in our current population as well as the aetiology of AA amyloidosis. To describe clinical outcomes, renal involvement and survival. PATIENTS AND METHODS: We performed a descriptive analysis of all cases of amyloidosis diagnosed from 1992 to 2004 in our hospital. Diagnosis was assessed on histological criteria: positivity Congo Red stain. Clinical data, renal involvement, dialysis treatment and survival were analysed. RESULTS: 76 cases, 44 women, mean age 70.7 +/- 12. Types: 55 AA (72%), 21 AL (28%) systemic amyloidosis. AA aetiology was: 66% rheumatic disorders, 28% infectious disease, 6% others. Incidence for AL was 4.6 and for AA 12.2 cases/million. Renal involvement was present in 75% at diagnosis (69% Creatinine clearance < 60 ml/min, 37% urinary protein > 3 g/24 hours). 21 cases (28%) progressed to renal disease stage V in the 8.1 +/- 9.8 months follow up period, and 14 cases started dialysis treatment (10 HD, 4 CAPD). In 7 cases (33%) dialysis was not indicated due to their poor clinical condition, short life expectancy and bad quality of life. Mean global survival at diagnosis was 55% and 40% at 12 and 24 months (AL 58% and 19%; AA 55% and 44%). Mean survival from the start of dialysis was 30% and 5% at 12 and 24 months. CONCLUSIONS: Although amyloidosis has a low incidence in our population, the kidney is usually involved. Rheumatological disorders are the principal aetiology of AA amyloidosis. Long term survival is poor, specially for AL.

Afectación renal en la amiloidosis. Características clínicas, evolución y supervivencia / Renal involvement in amyloidosis. Clinical outcomes, evolution and survival

Fundamento: La amiloidosis es una enfermedad sistémica caracterizada por eldepósito extracelular de material proteico fibrilar en disposición en lámina betaplegada. Las principales formas de amiloidosis sistémicas son la amiloidosis primaria(AL) y la secundaria (AA). La afectación renal es frecuente, confiriéndoleun pronóstico poco favorable. En los últimos años estamos asistiendo a un cambioen la etiología de las formas secundarias.Objetivo: Analizar la incidencia de AL y AA en nuestra área de referencia así comola etiología de AA. Describir la presentación clínica, la afectación renal y la evolución.Material y métodos: Análisis descriptivo de los casos de amiloidosis de nuestrohospital en el período 1992-2004. Criterio diagnóstico: histología positiva para RojoCongo. Se analizan las variables clínicas, afectación renal, inclusión en diálisis ysupervivencia.Resultados: Setenta y seis casos, 44 mujeres, edad media 70,7 ± 12. Tipos: 55AA (72%), 21 AL (28%), etiología AA: 66% reumatológicas, 28% infecciosas, 6%otras. La incidencia fue: AL 4,6 y AA 12,2 casos /millón. El 75% tenían afectaciónrenal al diagnóstico (69% ClCreat 3 g/24horas). 21 casos (28%) evolucionaron a insuficiencia renal grado V en un tiempomedio de 8,1 ± 9,8 meses, iniciando diálisis 14 pacientes (10 HD, 4 CAPD).En 7 casos (33%) no recibieron tratamiento dialítico por la importante afectacióndel estado general y la mala calidad de vida. La supervivencia actuarial globaldesde el momento del diagnóstico fue de 55% y 40% a los 12 y 24 meses (AL58% y 19%; AA 55% y 44%). La supervivencia actuarial desde el inicio de diálisisfue de 30% y 5% a los 12 y 24 meses.Conclusiones: Aunque la amiloidosis es una patología con escasa incidencia enla población general, la afectación renal es muy frecuente. Las enfermedades reumatológicasson la principal causa de AA. La supervivencia es limitada, especialmentepara las formas AL

Background: Systemic amyloidosis is a disease resulting from extracellular depositionof fibrillar protein in various organs. Main systemic amyloidosis are: primary (AL) and Secondary (AA). The kidney is usually involved, conferring and adverseprognosis. In the last decade there has been a change in the aetiology ofAA amyloidosis.Objectives: To analyse the incidence of AL and AA amyloidosis in our currentpopulation as well as the aetiology of AA amyloidosis. To describe clinical outcomes,renal involvement and survival.Patients and methods: We performed a descriptive analysis of all cases of amyloidosisdiagnosed from 1992 to 2004 in our hospital. Diagnosis was assessed onhistological criteria: positivity Congo Red stain. Clinical data, renal involvement,dialysis treatment and survival were analysed.Results: 76 cases, 44 women, mean age 70.7 ± 12. Types: 55 AA (72%), 21AL (28%) systemic amyloidosis. AA aetiology was: 66% rheumatic disorders, 28%infectious disease, 6% others. Incidence for AL was 4.6 and for AA 12.2 cases/million. Renal involvement was present in 75% at diagnosis (69% Creatinine clearance 3 g/24 hours). 21 cases (28%) progressedto renal disease stage V in the 8.1 ± 9.8 months follow up period, and14 cases started dialysis treatment (10 HD, 4 CAPD). In 7 cases (33%) dialysiswas not indicated due to their poor clinical condition, short life expectancy andbad quality of life. Mean global survival at diagnosis was 55% and 40% at 12and 24 months (AL 58% and 19%; AA 55% and 44%). Mean survival from thestart of dialysis was 30% and 5% at 12 and 24 months.Conclusions: Although amyloidosis has a low incidence in our population, thekidney is usually involved. Rheumatological disorders are the principal aetiologyof AA amyloidosis. Long term survival is poor, specially for AL

¿Influye la agitacion intensa del efluente peritoneal para el calculo de la dosis de dialisis en dialisis peritoneal automatica? / Peritoneal fluid agitation and dialysis dose estimation in automatic peritoneal analysis

No disponible

Afectación renal en la amiloidosis. Características clínicas, evolución y supervivencia / Renal involvement in amyloidosis. Clinical outcomes, evolution and survival

Fundamento: La amiloidosis es una enfermedad sistémica caracterizada por el depósito extracelular de material proteico fibrilar en disposición en lámina beta plegada. Las principales formas de amiloidosis sistémicas son la amiloidosis primaria (AL) y la secundaria (AA). La afectación renal es frecuente, confiriéndole un pronóstico poco favorable. En los últimos años estamos asistiendo a un cambio en la etiología de las formas secundarias. Objetivo: Analizar la incidencia de AL y AA en nuestra área de referencia así como la etiología de AA. Describir la presentación clínica, la afectación renal y la evolución. Material y métodos: Análisis descriptivo de los casos de amiloidosis de nuestro hospital en el período 1992-2004. Criterio diagnóstico: histología positiva para Rojo Congo. Se analizan las variables clínicas, afectación renal, inclusión en diálisis y supervivencia. Resultados: Setenta y seis casos, 44 mujeres, edad media 70,7 ± 12. Tipos: 55 AA (72%), 21 AL (28%), etiología AA: 66% reumatológicas, 28% infecciosas, 6% otras. La incidencia fue: AL 4,6 y AA 12,2 casos /millón. El 75% tenían afectación renal al diagnóstico (69% ClCreat 3 g/24 horas). 21 casos (28%) evolucionaron a insuficiencia renal grado V en un tiempo medio de 8,1 ± 9,8 meses, iniciando diálisis 14 pacientes (10 HD, 4 CAPD). En 7 casos (33%) no recibieron tratamiento dialítico por la importante afectación del estado general y la mala calidad de vida. La supervivencia actuarial global desde el momento del diagnóstico fue de 55% y 40% a los 12 y 24 meses (AL 58% y 19%; AA 55% y 44%). La supervivencia actuarial desde el inicio de diálisis fue de 30% y 5% a los 12 y 24 meses. Conclusiones: Aunque la amiloidosis es una patología con escasa incidencia en la población general, la afectación renal es muy frecuente. Las enfermedades reumatológicas son la principal causa de AA. La supervivencia es limitada, especialmente para las formas AL

Background: Systemic amyloidosis is a disease resulting from extracellular deposition of fibrillar protein in various organs. Main systemic amyloidosis are: primary (AL) and Secondary (AA). The kidney is usually involved, conferring and adverse prognosis. In the last decade there has been a change in the aetiology of AA amyloidosis. Objectives: To analyse the incidence of AL and AA amyloidosis in our current population as well as the aetiology of AA amyloidosis. To describe clinical outcomes, renal involvement and survival. Patients and methods: We performed a descriptive analysis of all cases of amyloidosis diagnosed from 1992 to 2004 in our hospital. Diagnosis was assessed on histological criteria: positivity Congo Red stain. Clinical data, renal involvement, dialysis treatment and survival were analysed. Results: 76 cases, 44 women, mean age 70.7 ± 12. Types: 55 AA (72%), 21 AL (28%) systemic amyloidosis. AA aetiology was: 66% rheumatic disorders, 28% infectious disease, 6% others. Incidence for AL was 4.6 and for AA 12.2 cases/ million. Renal involvement was present in 75% at diagnosis (69% Creatinine clearance 3 g/24 hours). 21 cases (28%) progressed to renal disease stage V in the 8.1 ± 9.8 months follow up period, and 14 cases started dialysis treatment (10 HD, 4 CAPD). In 7 cases (33%) dialysis was not indicated due to their poor clinical condition, short life expectancy and bad quality of life. Mean global survival at diagnosis was 55% and 40% at 12 and 24 months (AL 58% and 19%; AA 55% and 44%). Mean survival from the start of dialysis was 30% and 5% at 12 and 24 months. Conclusions: Although amyloidosis has a low incidence in our population, the kidney is usually involved. Rheumatological disorders are the principal aetiology of AA amyloidosis. Long term survival is poor, specially for AL

¿Influye la agitación intensa del efluente peritoneal para el cálculo de la dosis de diálisis en diálisis peritoneal automática? / No disponible

No disponible

¿Un nuevo caso de enfermedad por hantavirus en España? / No disponible

No disponible

Evaluación del metabolismo óseo a largo plazo en los pacientes con hipoparatiroidismo relativo tras cambiar la concentración de calcio del dializado a 3 mEq/L / Long term evaluation of bone metabolism in patients with relative hypoparathyroidism after lowering dialysate calcium concentration to 3 meq/l

La existencia de un estado óseo de bajo remodelado no relacionado con el aluminio ha ido adquiriendo importancia en los últimos años. La demostración de unos valores de PTHi excesivamente disminuidos permiten identificar con gran valor predictivo a este grupo de pacientes con especial riesgo de desarrollar una enfermedad ósea adinámica. Aparte del correcto manejo de los factores de riesgo previamente expuestos, existen pocas posibilidades más para actuar sobre el remodelado óseo. Una de ellas sería modificar la concentración de calcio en el dializado, aunque existe poca información sobre su repercusión a largo plazo sobre la masa ósea. El objetivo del presente estudio fue valorar el efecto a largo plazo de la disminución de concentración de calcio del líquido de diálisis de 3,5 a 3 mEq/L sobre la masa ósea y la actividad paratiroidea en los pacientes con hipoparatiroidismo. Se han estudiado 19 pacientes con PTHi < 120 pg/ml y calcemia entre8,5 y 10,5 mg/dl, sin evidencia de intoxicación alumínica. Se han controlado los valores de Ca, P, fosfatasa alcalina, aluminio, PTHi y dosis de diálisis cada (..) (AU)

The existance of a low-bone turnover, non-aluminium related, has been more prevalent in recent years. Factors involved include the increasing number of older and diabetic patients initiating dialysis. Also higher intake of calcium salts and the widespread use of vitamin D derivates may play a role. Demonstration of low PTH secretion allows the recognition of the group of patients with special risk of adynamic bone disease. Little can be done to improve bone remodelling apart from correct management of risk factors previously mentioned. Adecrease in dialysate calcium concentration can act in this way, but the long term effect of this procedure on bone mineral density has scarcely been established. The aim of this study was to evaluate the long term effect of lowering the dialysate calcium concentration from 3.5 to 3 mEq/L on bone mass and PTH activity in patients with hypoparathyroidism. We studied 19 patients with PTH < 120 pg/ml and calcemia between 8.5 and 10.5 mg/dl, without aluminium intoxication. Blood levels of Ca, P, alkaline phosphatase, aluminium, iPTH and dialysis doses were measured every 4 months during the two years of follow-up. Phosphate binders were closely monitored. Also calcium dietary feeding was measured by a 5-day dietetic registry at the beginning and 6 and 12 months later. Bone mineral density was (..) (AU)

[Patients with end-stage chronic renal insufficiency on programmed withdrawal from dialysis]. / Pacientes con insuficiencia renal crónica terminal retirados de diálisis bajo protocolización.

UNLABELLED: The voluntary discontinuation of dialysis by patients is a common mode of death in dialysis programmes. Unfortunately the Spanish experience has not been related in the nephrological literature. Initiation of, and withdrawal from, dialysis pose ethical questions for medicine in the 21st century. The dialysis population is aging and they have multiple medical problems. The choice may be between prolongation of quantity or quality of life. We evaluated a protocol for initiation of dialysis in patients with end stage renal failure and their subsequent withdrawal. We determined the factors predicting withdrawal of dialysis and revised the protocol to take account of these. We carried out an opinion poll of doctors and nurses about the effectiveness of the protocol. We studied prospectively the reasons for death of patients in the last seven years. RESULTS: Thirty patients were withdrawn from dialysis out of 116 who died during treatment by hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) in the last seven years. Vascular nephropathy is the principal disease predicting withdrawal from dialysis; the main precipitating cause is mental incapacity. The availability of a protocol for withdrawal of dialysis is well received by doctors and nurses and it engenders moral and legal calm when facing difficult decisions. Twenty-six per cent of deaths on regular dialysis are the result of withdrawal of treatment.

Pacientes con insuficiencia renal crónica terminal retirados de diálisis bajo protocolización / Voluntary discontinuation of dialysis

La retirada de diálisis no es motivo de investigación ni de tratamiento habitual en la literatura nefrológica española. Es un tema de debate que conlleva disyuntivas de tipo ético. Su presentación es frecuente actualmente en la clínica diaria. Con la prolongación de expectativas de vida de los pacientes, aumentan los dilemas acerca de la prolongación de esa vida en las mínimas condiciones de calidad.Se comprueba la utilidad de un protocolo de entrada/retirada de pacientes con insuficiencia renal crónica terminal, diseñando los parámetros pronósticos de retirada de diálisis, y revisando los parámetros que inciden en la toma de decisión de esa retirada. Se realiza una encuesta a los profesionales sobre la efectividad del protocolo. Se revisan prospectivamente las causas de muerte acaecidas en los últimos siete años.Los resultados muestran 30 pacientes retirados del total de 116 enfermos fallecidos durante ese tiempo. La nefropatía vascular es la enfermedad que plantea con mayor frecuencia la retirada de diálisis, siendo la causa inmediata la incapacidad mental.La disponibilidad de un protocolo de retirada de diálisis confiere un aceptable grado de satisfacción entre los profesionales y les da tranquilidad moral y tal vez legal, a pesar del vacío existente en ese sentido, ante unas tomas de decisiones eventualmente conflictivas, dado que un 26 por ciento de los fallecimientos son debidos a esa retirada. (AU)

[Assessment of long-term bone metabolism in patients with relative hypoparathyroidism after changing the calcium concentration of the dialyzate to 3mEq/L]. / Evaluación del metabolismo óseo a largo plazo en los pacientes con hipoparatiroidismo relativo tras cambiar la concentración de calcio del dializado a 3 mEq/L.

The existence of a low-bone turnover, non-aluminium related, has been more prevalent in recent years. Factors involved include the increasing number of older and diabetic patients initiating dialysis. Also higher intake of calcium salts and the widespread use of vitamin D derivates may play a role. Demonstration of low PTH secretion allows the recognition of the group of patients with special risk of adynamic bone disease. Little can be done to improve bone remodelling apart from correct management of risk factors previously mentioned. A decrease in dialysate calcium concentration can act in this way, but the long term effect of this procedure on bone mineral density has scarcely been established. The aim of this study was to evaluate the long term effect of lowering the dialysate calcium concentration from 3.5 to 3 mEq/L on bone mass and PTH activity in patients with hypoparathyroidism. We studied 19 patients with PTH < 120 pg/ml and calcemia between 8.5 and 10.5 mg/dl, without aluminium intoxication. Blood levels of Ca, P, alkaline phosphatase, aluminium, iPTH and dialysis doses were measured every 4 months during the two years of follow-up. Phosphate binders were closely monitored. Also calcium dietary feeding was measured by a 5-day dietetic registry at the beginning and 6 and 12 months later. Bone mineral density was assessed by quantitative computed tomography of the distal radius initially and after 18 months. PTH values had significantly increased from the first measurement (from 46 +/- 33 to 97 +/- 68 four months later). At the end of follow up, 8 patients (42%) had reached the objective of maintaining a PTHi above 120 pg/ml, while 11 had not reached it (3 were previously parathyroidectomized and two were diabetic). Only one patient has developed an exaggerated PTH response that has been controlled with oral vitamin D. No bone mineral loss was observed during the follow up. In conclusion, the use of a 3 mEq/l dialysate calcium may improve hypoparathyroidism in a substantial number of patients, avoiding the untoward effect that lower calcium concentration has on bone mineralization.

Nursing protocol for manipulation of haemodialysis catheters.

This study looked at the incidence of infection complications, in relation to central vein catheterisation as a provisional HD access, by means of the establishment of a nursing protocol for the handling of these catheters. Central vein catheterisation is a classical technique in Nephrology.