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1.
J Am Soc Nephrol ; 24(4): 665-76, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23471197

RESUMO

Little information exists regarding the efficacy, modifiers, and outcomes of anemia management in children with CKD or ESRD. We assessed practices, effectors, and outcomes of anemia management in 1394 pediatric patients undergoing peritoneal dialysis (PD) who were prospectively followed in 30 countries. We noted that 25% of patients had hemoglobin levels below target (<10 g/dl or <9.5 g/dl in children older or younger than 2 years, respectively), with significant regional variation; levels were highest in North America and Europe and lowest in Asia and Turkey. Low hemoglobin levels were associated with low urine output, low serum albumin, high parathyroid hormone, high ferritin, and the use of bioincompatible PD fluid. Erythropoiesis-stimulating agents (ESAs) were prescribed to 92% of patients, and neither the type of ESA nor the dosing interval appeared to affect efficacy. The weekly ESA dose inversely correlated with age when scaled to weight but did not correlate with age when normalized to body surface area. ESA sensitivity was positively associated with residual diuresis and serum albumin and inversely associated with serum parathyroid hormone and ferritin. The prevalence of hypertension and left ventricular hypertrophy increased with the degree of anemia. Patient survival was positively associated with achieved hemoglobin and serum albumin and was inversely associated with ESA dose. In conclusion, control of anemia in children receiving long-term PD varies by region. ESA requirements are independent of age when dose is scaled to body surface area, and ESA resistance is associated with inflammation, fluid retention, and hyperparathyroidism. Anemia and high ESA dose requirements independently predict mortality.


Assuntos
Anemia/tratamento farmacológico , Hematínicos/uso terapêutico , Diálise Peritoneal/efeitos adversos , Insuficiência Renal Crônica/complicações , Adolescente , Anemia/sangue , Criança , Pré-Escolar , Feminino , Hematínicos/administração & dosagem , Hemoglobinas , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Prevalência , Estudos Prospectivos , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/terapia , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
2.
Int Urol Nephrol ; 37(3): 571-4, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16307344

RESUMO

The purpose of this paper is to describe the risks of ventriculopleural shunt in patients with spina bifida and end-stage-renal-diseases (ESRD), and to describe endoscopic third ventriculostomy as an alternative for the combination of cerebrospinal shunt and dialysis modality. We report a 16-year-old boy with spina bifida on chronic dialysis with a massive unilateral hydrothorax and respiratory distress complicating a ventriculopleural (VPL) shunt. Two thoracocenteses were performed, draining 3200 ml of a clear fluid. The VPL shunt was removed and revised successfully to a third ventriculostomy (TVE). Peritoneal dialysis (PD) was the initial dialysis modality. After 12 months on PD, the patient was transferred to hemodialysis (HD) because of refractory peritonitis. Hydrothorax developed while the patient was on PD, reaching its maximum 2 months after the transference to HD. To our knowledge there has been no other report of ventriculopleural (VPL) shunt failure, and endoscopic TVE, as a cerebrospinal fluid (CSF) diversion alternative in patients on chronic dialysis.


Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Hidrotórax/etiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Disrafismo Espinal/epidemiologia , Disrafismo Espinal/terapia , Terceiro Ventrículo/cirurgia , Ventriculostomia , Adolescente , Derivações do Líquido Cefalorraquidiano/métodos , Humanos , Hidrotórax/cirurgia , Masculino
3.
Pediatr Nephrol ; 20(9): 1315-9, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15942784

RESUMO

In this study we analyze the impact of the patient's socioeconomic status (SES) and the distance from the patient's home to the dialysis center (DPH-DC), classified as < or =300 km or >300 km, on the patient and technique survival of 59 patients starting chronic peritoneal dialysis (CPD) between May 1983 and January 2004 at a single center in Uruguay. SES was established using Graffar's method. Mean duration of CPD was 38.1+/-26.0 months. Mean age at the start of CPD was 8.4+/-5.2 years. Overall patient and technique survival at 5 years were 86.4% and 77.9%, respectively. Twenty (33.8%) patients were transferred to hemodialysis. Eight (13.5%) patients died. The incidence of peritonitis was one episode every 9.1 months. There was no statistically significant difference in patient and technique survival between the patients in the low and high SES groups (p=0.72 and 0.99, respectively), and between those in the two DPH-DC groups, (p=0.22 and p=0.99, respectively). Logistic regression analysis confirmed low SES and DPH-DC >300 km are not predictors of patient death (p=0.79 and p=0.09, respectively) or technical failure (p=0.35 and p=0.15, respectively). No SES- and DPH-DC-related statistically significant differences were found in patient and technique survival.


Assuntos
Países em Desenvolvimento , Acessibilidade aos Serviços de Saúde , Diálise Peritoneal/mortalidade , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Masculino , Diálise Peritoneal/métodos , Pobreza , Fatores Socioeconômicos , Análise de Sobrevida , Uruguai
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