[The role of the vascular surgeon in improvement of organization of dialysis help]. / Rol' angiokhirurga v uluchshenii organizatsii dializnoi pomoshchi.

Analysed herein are one-year results of formation of arteriovenous fistulas in 109 patients with end-stage chronic renal failure, as well as therapeutic decision-making after angiosurgical counselling of 144 patients presenting with 'problem' permanent vascular accesses. The counselling and formation of arteriovenous fistulas were carried out in conditions of interdepartmental collaboration between outpatient centres dealing with haemodialysis and vascular surgeons specialized in ultrasound mapping of peripheral vessels and performing different variants of arteriovenous fistulas. The angiosurgical care was as close to the patient as possible. Of the 109 operated patients, primary arteriovenous fistulas were made in 46 (42.2%) cases, secondary AVF - in 27 (24.8%) cases, and reconstruction of AVF - in 36 (33.0%) cases. Of the 144 patients with 'problem' permanent vascular assesses, correction of arteriovenous fistulas turned out impossible in 13 (9.1%). In the remaining 131 (90.9%) patients there was a possibility of different variants of open reconstruction of arteriovenous fistulas or performing angioplasty. Active policy of vascular surgeons in interdepartmental collaboration with nephrologists made it possible to bridge over the difficulties of patients routing which resulted in reduction of the terms of formation of arteriovenous fistulas by 2 months. Preventive arteriovenous fistulas were carried out in 17.4% of cases of primary permanent vascular assesses. During a year after formation of permanent vascular accesses, the number of patients with vascular catheters in ambulatory centres decreased from 22 to 17%. These positive changes in organization of the dialysis treatment made it possible to reduce the risks of infectious complications, to obtain adequate blood flow characteristics for haemodialysis procedures, as well as to decrease financial expenses and labour costs for AVF care.

[Bilateral nephrectomy in patients with end-stage renal failure and chronic active pyelonephritis].

This study analyzed the results of bilateral nephrectomy in 14 patients with end-stage renal disease (ESRD) and chronic active pyelonephritis. Seven patients had urosepsis, and 10 patients had a purulent form of pyelonephritis, which was one-sided in 7 of them. In the early postoperative period, on average, after 9.3 days, 9 patients died. Statistically significant risk factors for death were: chronic hemodialysis, long-term antibiotic therapy, and existing sepsis. Intraoperative complications and postoperative morbidity were not significantly associated with death. The study results imply the need of differentiated approach to bilateral nephrectomy in patients with ESRD and risk factors for fatal outcome. It must be performed on the strong indications since the intervention does not lead to eradication of sepsis. It is advisable to perform "preventive, sanation" bilateral nephrectomy in the "cold period" in patients at risk for developing urosepsis.

Incidencia del virus C de la hepatitis en pacientes en hemodiálisis / Incidence of hepatitis C virus in hemodyalisis patients

Se realizó un estudio descriptivo y transversal de 107 pacientes con insuficiencia renal crónica terminal, tratados periódicamente con hemodiálisis en el Servicio de Hemodiálisis del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, de enero a junio del 2012, quienes habían recibido al menos 3 transfusiones sanguíneas y además presentaban el virus de la hepatitis C -- confirmado por el método inmunoenzimático de ELISA --, a fin de caracterizarles y determinar en ellos la morbilidad de dicho virus. En la investigación se obtuvo una preponderancia del sexo masculino (53,0 %), el grupo etario de 45-54 años (30,0 %) y la nefropatía hipertensiva como causa de insuficiencia renal crónica (50,5 %); además, se realizaron menos de 3 transfusiones en 48 pacientes (51,0 %). El virus de la hepatitis C mantenía una alta morbilidad en los pacientes con insuficiencia renal crónica terminal que recibieron tratamiento hemodialítico en este Servicio de Hemodiálisis.

A descriptive and cross-sectional study was carried out in 107 patients with end-stage chronic renal failure, treated with periodic hemodyalisis at the Hemodyalisis Service of "Dr. Juan Bruno Zayas Alfonso" General Teaching Hospital of Santiago de Cuba, from January to June 2012, who received at least three blood transfusions and also had the hepatitis C virus -- confirmed by ELISA immunoassay method--, in order to characterize them and to determine the virus morbidity in them. There was a predominance of males (53.0%), the age group of 45-54 years (30.0%) and hipertensive nephropathy as a cause of chronic renal failure (50.5%) in the study; also, less than three transfusions were made in 48 patients (51.0%). The hepatitis C virus remained a high morbidity in patients with end-stage chronic renal failure who received hemodyalisis in this Hemodyalisis Service.

Síntomas gastrointestinales y hallazgos de endoscopia digestiva superior en niños con insuficiencia renal crónica terminal: Hospital "J.M. de Los Ríos" Caracas, Venezuela / Gastrointestinal symptoms and upper gastrointestinal endoscopical findings in children with end-stage chronic renal failure: Hospital

Los pacientes con Enfermedad Renal Crónica Estadio V (ERC) conocida como insuficiencia renal terminal pueden manifestar una serie de lesiones gastrointestinales y sufrir complicaciones. Investigar los hallazgos clínicos y endoscópicos en pacientes pediátricos con esta condición. Durante un período de 5 años (Enero de 2004 a Diciembre de 2008), fueron evaluados en el servicio de Gastroenterología practicándoseles endoscopia digestiva superior antes del trasplante renal. Se estudiaron 75 pacientes 37 femeninos, 38 masculinos, edad promedio 12 años; 42,7% fueron asintomáticos y 57,3% experimentaron síntomas: pirosis (23,2%), reflujo (23,2%), dolor abdominal (18,7%), distensión abdominal (14%), vómitos (9,3%), náuseas (7%) y hematemesis (4,6%). La endoscopia reportó normal en 18 pacientes (24%). Endoscopia anormal: gastropatía erosiva (43,9%), duodenitis (24,5%), gastropatía nodular (14%), esofagitis (14%) y hernia hiatal (3,5%). Presencia de Helicobacter pylori en 22,7%. Se determinó que la evaluación endoscópica debe ser incluida en pacientes con protocolo pretrasplante renal, ya que estos presentan alteraciones gastrointestinales variadas...

Patients with Stage 5 Chronic Kidney Disease (CKD), known as end-stage renal disease (ESRD), may manifest a variety of gastrointestinal lesions and suffer complications. To investigate the clinical and endoscopic findings in pediatric patients with this condition. Over a period of 5 years (January 2004 to December 2008), the patients were evaluated in the pediatric gastroenterology service by upper gastrointestinal endoscopy before kidney transplant. We studied 75 patients: 37 female and 38 male, with a mean age of 12 years-old; 42.7% were asymptomatic and 57.3% experienced symptoms: heartburn (23.2%), reflux (23.2%), abdominal pain (18.6%), abdominal distension (14%), vomiting (9.3%), nausea (7%) and hematemesis (4.6%). Endoscopy reported normal in 18 patients (24%) and the remaining study was abnormal: erosive gastropathy (43.9%), duodenitis (24.5%), nodular gastropathy (14%), esophagitis (14%) and hiatal hernia (3.5%). Presence of Helicobacter pylori (22.7%). We determined that endoscopic evaluation should be included in patients with pre-renal transplant protocol, since they have various gastrointestinal disorders that may influence the evolution and prognosis of the transplant...

Impacto de la malnutrición sobre la mortalidad en los pacientes en hemodiálisis crónica / Impact of malnutrition on mortality in chronic hemodialysis patients

Se realizó un diseño de estudio de casos y controles que comparó un grupo de 20 pacientes fallecidos (casos) con 27 pacientes vivos (controles), donde se les determinó el estado nutricional y se correlacionó con la frecuencia de muerte. Se llevó la información a tablas de contingencia para la estimación del odds ratio (OR) y se empleó la regresión logística multivariada para estimar la fuerza de asociación entre el conjunto de variables estudiadas. Los casos presentaron valores medios de urea, colesterol y creatinina inferiores a los controles. Del total de 20 casos, 19 presentaron malnutrición proteico-energética para un OR de 13 y un IC del 95 % de 112,4 (p=0,005). En el análisis de regresión logística multivariada la malnutrición proteico-energética se relacionó con la mortalidad, con un coeficiente de 2,49, un OR de 12,07 y un intervalo de confianza del 95 % de 105,15 (p<0,05). La malnutrición proteico-energética es un fuerte predictor de mortalidad y la valoración subjetiva global nutricional es un método eficaz para demostrar diferentes grados de desnutrición y predecir la mortalidad en los pacientes con insuficiencia renal crónica terminal en hemodiálisis.

A case -control study design was made to compare a group of 20 dead patients (cases) with 27 living patients (controls). Their nutritional state was determined and correlated to death frequency. The information was shown in contingency tables to estimate odds ratio (OR) and the multivariate logistic regression was used to calculate the association strength between the series of studied variables. The cases presented mean values of urea, cholesterol and creatinine lower than the controls. Of the total of 20 cases, 19 showed protein-energy malnutrition for an OR of 13 and a confidence interval of 95 %, 11.4 (p = 0.005). In the analysis of multivariate logistic regression the protein-energy malnutrition was related to mortality with a coefficient of 2.49, an OR of 12.07 and a confidence interval of 95.%, 105.15 (p 0.05). The protein-energy malnutrition is a strong predictor of mortality and the global subjective nutritional assessment is an efficient method to show different degrees of malnourishment and to predict mortality in patients with end-stage chronic renal failure on hemodialysis.