Metformin-associated lactic acidosis (MLA) is a rare but fatal complication. Data reveal that the... more Metformin-associated lactic acidosis (MLA) is a rare but fatal complication. Data reveal that the incidence of MLA is less than 5.1 cases per 100,000 patient years with the mortality rate of 30-50%. The aim of the study was to determine the incidence of MLA in patients with diabetes admitted in our hospital and to identify the predisposing medical conditions, prognostic factors and outcome of these patients. We also compared our results with previously published data to identify specific features of MLA and formulate recommendations regarding our population. Retrospective analysis of all cases of lactic acidosis admitted in our hospital between 2006 and 2010 was done. Lactic acidosis (LA) was defined by serum pH < 7.35 and serum lactate ≥ 4 mmol/l. Eleven cases of MLA (4.35% of the total cases of acidosis) were observed. The average age was 71.0 12.9 years. Mean dosage was 2000 mg/day. The cause was identified as an acute gastrointestinal event with dehydration and hypovolemia ...
Background and Aims Quality of life (QoL) is an important indicator of quality of healthcare. Mea... more Background and Aims Quality of life (QoL) is an important indicator of quality of healthcare. Measuring QoL and its correlates for peritoneal dialysis (PD) patients is very important for intervention and clinical decision-making. Being a technique performed by the patients themselves, their perspective of health related QoL is extremely important. The EuroQol questionnaire evaluates 5 QoL dimensions (mobility, self-care, usual activities, pain/ discomfort and anxiety/ depression) and includes a visual analogue scale (VAS) rated 0-100% that provides a quantitative measure of the patients’ perception of their overall health. Method Data from 69 patients on peritoneal dialysis at our center were collected using EQ-5D-5L EuroQol questionnaire. Health state index (HSI) scores were calculated from individual health profiles using the Spanish value set (maximum score 1). Additional clinical and laboratory data was collected from the patient’s medical files. Results Mean age of the populati...
Cephalic arch stenosis (CAS) is an important and recurring problem arising in hemodialysis patien... more Cephalic arch stenosis (CAS) is an important and recurring problem arising in hemodialysis patients because of the requirement for repeated interventions to maintain patency. The aim of this study was to determine predictive factors for recurrence of CAS after successful angioplasty. A retrospective, case-control study was conducted at two ambulatory vascular access (VA) centers. All patients with a dysfunctional VA referred for an angiographic procedure and with a documented CAS as evidenced during the endovascular intervention (EI) between January 1, 2013, and December 31, 2015, were enrolled; 15 patients in whom an efficacious intervention was not possible were excluded. The study thus concerned 375 EIs using percutaneous transluminal angioplasty without stent placement on 241 VAs for CAS (9% of all procedures performed) during a 3-year period. Patients were compared regarding the absence (group 1; n = 181) or presence (group 2; n = 60) of recurrent CAS. We defined recurrence as ...
Over the few last decades, several additional urinary biomarkers have been correlated to other or... more Over the few last decades, several additional urinary biomarkers have been correlated to other organ or system abnormalities other than kidney disease. In this setting, abnormal findings on a routine urinalysis, often in an otherwise asymptomatic patient, may be the first evidence of underlying kidney disease and even other diseases or conditions like a higher cardiovascular risk set. A 24-h urine evaluation is still considered the gold standard method for the quantification of important urinary biomarkers like proteinuria. Nevertheless, its collection is laborious and entails significant errors that could compromise the accuracy of this method. Therefore, random spot urine assessment was developed to estimate quantitative measurements of 24-h collections. Many trials have been conducted to determine which formulae (correction for other parameters) and methods (including voiding of the day or technical procedures) are better to minimize sources of false results and enhance correlation with the gold standard. Currently, random spot urine examination is already mentioned in some international guidelines as an alternative analysis to diagnose and monitor several diseases. It allows the identification of multiple markers, which can be organized into three groups, according to their laboratory method assessment: physical, chemical, and microscopic characters. However, evidence regarding its role and power is still not unanimous, at least in some diseases, and future trials to prove how best to apply it are needed. This review outlines random spot urine biomarkers for the kidney and their applications in clinical practice.
Nefrología : publicación oficial de la Sociedad Española Nefrologia, 2014
Cardiovascular (CV) disease is the major cause of mortality in patients undergoing renal replacem... more Cardiovascular (CV) disease is the major cause of mortality in patients undergoing renal replacement therapy. The primary aim of the study was to evaluate the CV risk profile and prevalence of CV disease in patients on peritoneal dialysis (PD) in Portugal. The secondary goal was to establish parameters most associated with CV disease. Retrospective, multicenter study of the prevalent adult population on PD. Six hundred patients were included (56.7% male; mean age 53.5 ± 15.3 years), on PD for 25.6 ± 21.9 months. Patients were divided into two groups: group 1 (n=166) with CV disease and group 2 (n=434) without CV disease. Comparisons were made regarding traditional CV risk factors and those associated with uremia and PD itself, and a multivariate analysis was performed to determine variables independently associated with CV disease. At the end of the study, the prevalence of CV disease was 28%. At univariate analysis, group 1 presented a higher frequency of males (p<.01), older pa...
Physical examination (PE), and surveillance and monitoring techniques should be a core part of st... more Physical examination (PE), and surveillance and monitoring techniques should be a core part of standard care provided to hemodialysis patients. This study aimed to define which referral criteria within a vascular access (VA) program were associated with indication for therapeutic endovascular intervention (EI). Retrospective study at two vascular centers, considering 1265 procedures between 1 November 2012 and 30 November 2013. All 617 arteriovenous fistulas (AVFs) and 648 arteriovenous grafts (AVGs) referred for angiography were enrolled. Each population was divided into two groups regarding absence (group 1) or presence (group 2) of a significant lesion on the angiogram, contemplating formal indication for EI. On multivariate analysis, factors independently associated with presence of a significant lesion in AVFs were referral due to increased dynamic venous pressure (p = 0.01), suspected stenosis by abnormal PE (p = 0.019), confirmed reduction in access flow rate (p = 0.003), and...
Metformin-associated lactic acidosis (MLA) is a rare but fatal complication. Data reveal that the... more Metformin-associated lactic acidosis (MLA) is a rare but fatal complication. Data reveal that the incidence of MLA is less than 5.1 cases per 100,000 patient years with the mortality rate of 30-50%. The aim of the study was to determine the incidence of MLA in patients with diabetes admitted in our hospital and to identify the predisposing medical conditions, prognostic factors and outcome of these patients. We also compared our results with previously published data to identify specific features of MLA and formulate recommendations regarding our population. Retrospective analysis of all cases of lactic acidosis admitted in our hospital between 2006 and 2010 was done. Lactic acidosis (LA) was defined by serum pH < 7.35 and serum lactate ≥ 4 mmol/l. Eleven cases of MLA (4.35% of the total cases of acidosis) were observed. The average age was 71.0 12.9 years. Mean dosage was 2000 mg/day. The cause was identified as an acute gastrointestinal event with dehydration and hypovolemia ...
Background and Aims Quality of life (QoL) is an important indicator of quality of healthcare. Mea... more Background and Aims Quality of life (QoL) is an important indicator of quality of healthcare. Measuring QoL and its correlates for peritoneal dialysis (PD) patients is very important for intervention and clinical decision-making. Being a technique performed by the patients themselves, their perspective of health related QoL is extremely important. The EuroQol questionnaire evaluates 5 QoL dimensions (mobility, self-care, usual activities, pain/ discomfort and anxiety/ depression) and includes a visual analogue scale (VAS) rated 0-100% that provides a quantitative measure of the patients’ perception of their overall health. Method Data from 69 patients on peritoneal dialysis at our center were collected using EQ-5D-5L EuroQol questionnaire. Health state index (HSI) scores were calculated from individual health profiles using the Spanish value set (maximum score 1). Additional clinical and laboratory data was collected from the patient’s medical files. Results Mean age of the populati...
Cephalic arch stenosis (CAS) is an important and recurring problem arising in hemodialysis patien... more Cephalic arch stenosis (CAS) is an important and recurring problem arising in hemodialysis patients because of the requirement for repeated interventions to maintain patency. The aim of this study was to determine predictive factors for recurrence of CAS after successful angioplasty. A retrospective, case-control study was conducted at two ambulatory vascular access (VA) centers. All patients with a dysfunctional VA referred for an angiographic procedure and with a documented CAS as evidenced during the endovascular intervention (EI) between January 1, 2013, and December 31, 2015, were enrolled; 15 patients in whom an efficacious intervention was not possible were excluded. The study thus concerned 375 EIs using percutaneous transluminal angioplasty without stent placement on 241 VAs for CAS (9% of all procedures performed) during a 3-year period. Patients were compared regarding the absence (group 1; n = 181) or presence (group 2; n = 60) of recurrent CAS. We defined recurrence as ...
Over the few last decades, several additional urinary biomarkers have been correlated to other or... more Over the few last decades, several additional urinary biomarkers have been correlated to other organ or system abnormalities other than kidney disease. In this setting, abnormal findings on a routine urinalysis, often in an otherwise asymptomatic patient, may be the first evidence of underlying kidney disease and even other diseases or conditions like a higher cardiovascular risk set. A 24-h urine evaluation is still considered the gold standard method for the quantification of important urinary biomarkers like proteinuria. Nevertheless, its collection is laborious and entails significant errors that could compromise the accuracy of this method. Therefore, random spot urine assessment was developed to estimate quantitative measurements of 24-h collections. Many trials have been conducted to determine which formulae (correction for other parameters) and methods (including voiding of the day or technical procedures) are better to minimize sources of false results and enhance correlation with the gold standard. Currently, random spot urine examination is already mentioned in some international guidelines as an alternative analysis to diagnose and monitor several diseases. It allows the identification of multiple markers, which can be organized into three groups, according to their laboratory method assessment: physical, chemical, and microscopic characters. However, evidence regarding its role and power is still not unanimous, at least in some diseases, and future trials to prove how best to apply it are needed. This review outlines random spot urine biomarkers for the kidney and their applications in clinical practice.
Nefrología : publicación oficial de la Sociedad Española Nefrologia, 2014
Cardiovascular (CV) disease is the major cause of mortality in patients undergoing renal replacem... more Cardiovascular (CV) disease is the major cause of mortality in patients undergoing renal replacement therapy. The primary aim of the study was to evaluate the CV risk profile and prevalence of CV disease in patients on peritoneal dialysis (PD) in Portugal. The secondary goal was to establish parameters most associated with CV disease. Retrospective, multicenter study of the prevalent adult population on PD. Six hundred patients were included (56.7% male; mean age 53.5 ± 15.3 years), on PD for 25.6 ± 21.9 months. Patients were divided into two groups: group 1 (n=166) with CV disease and group 2 (n=434) without CV disease. Comparisons were made regarding traditional CV risk factors and those associated with uremia and PD itself, and a multivariate analysis was performed to determine variables independently associated with CV disease. At the end of the study, the prevalence of CV disease was 28%. At univariate analysis, group 1 presented a higher frequency of males (p<.01), older pa...
Physical examination (PE), and surveillance and monitoring techniques should be a core part of st... more Physical examination (PE), and surveillance and monitoring techniques should be a core part of standard care provided to hemodialysis patients. This study aimed to define which referral criteria within a vascular access (VA) program were associated with indication for therapeutic endovascular intervention (EI). Retrospective study at two vascular centers, considering 1265 procedures between 1 November 2012 and 30 November 2013. All 617 arteriovenous fistulas (AVFs) and 648 arteriovenous grafts (AVGs) referred for angiography were enrolled. Each population was divided into two groups regarding absence (group 1) or presence (group 2) of a significant lesion on the angiogram, contemplating formal indication for EI. On multivariate analysis, factors independently associated with presence of a significant lesion in AVFs were referral due to increased dynamic venous pressure (p = 0.01), suspected stenosis by abnormal PE (p = 0.019), confirmed reduction in access flow rate (p = 0.003), and...
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