Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia
Latin America, a region composed of a series of neighboring countries that share their history, L... more Latin America, a region composed of a series of neighboring countries that share their history, Latin ancestry and language (Spanish or Portuguese), includes Mexico, Central America, the Spanish Caribbean islands, and South America. The Latin-American Dialysis and Kidney Transplantation Registry, which has been operative since 1991, collects data from 20 countries (Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Dominican Republic, Venezuela and Uruguay), where 97% of Latin Americans live. The prevalence of renal replacement therapy (RRT) has increased from 119 patients per million (pmp) in 1991 to 478.2 in 2005 (147,158 patients [57%] on chronic hemodialysis, 58,251 [23%] on peritoneal dialysis and 52,565 [20%] living with a functioning kidney graft). The incidence rate also increased from 27.8 pmp in 1992 to 167 in 2005. The increment in prevalence and incidence occurred in all Latin- American countries. The transplantation rate increased from 3,7 pmp in 1987 to 15 pmp in 2005 (7,968 kidney transplants performed this year, the cumulative number being 98,415). Access to RRT was available for every patient diagnosed with end-stage renal disease only in Argentina, Brazil, Chile, Cuba, Puerto Rico, Venezuela and Uruguay. In Latin America, the incidence and prevalence of RRT increased year by year. Only in some countries is access to RRT available to 100% of diagnosed patients. Detection and prevention programs for chronic kidney disease are needed in the region. Meanwhile, access to RRT has to be improved for everybody who needs it.
We analyzed retrospectively the outcome of 169 patients in chronic hemodialysis (CHD), divided in... more We analyzed retrospectively the outcome of 169 patients in chronic hemodialysis (CHD), divided into four groups: 1) 24 patients with diabetic nephropathy (age 53.7 +/- 11 years); 2) 19 with polycystic kidney disease (age 55.3 +/- 9 years) 3) 43 patients older than 60 when starting chronic hemodialysis with etiologies different from diabetes and polycystic kidney disease (age 69.2 +/- 5.8 years) and 4) 83 patients younger than 60 with diverse etiologies (age 42.8 +/- 12.4 years). In groups 1, 2 and 3 serum creatinine, arterial hypertension at the beginning, morbility, mortality and its causes were registered. In group 1, the prevalence of severe diabetic retinopathy and cardiovascular disease at the beginning were also analyzed. In all groups survival was determined. Of the diabetics, 92% presented severe diabetic retinopathy and 88% cardiovascular disease. The prevalence of hypertension was 100, 74 and 67% in groups 1, 2 and 3, respectively (p = 0.13). Twelve diabetics died before the first year of treatment; there was no difference in creatinine, age, cardiovascular disease, severe retinopathy and hypertension with those who lived more than one year. The percentage of time in risk hospitalized and the days/patients/year hospitalized were significantly different between group 1 and 3 and group 2 (p < 0.001). Patients were hospitalized for similar causes in groups 1 and 3: the initiation of CHD, cardiovascular and neurological diseases. The main causes of death in groups 1 and 3 were: cardiovascular disease and sudden death at home. Survival was better in group 2 compared with group 1 (p = 0.0014) but was similar between groups 1 and 3 (p = 0.21) even though there was a difference of 15 years between them. The Cox's proportional hazard model identified as risk factors diabetes, age, year of starting chronic hemodialysis and hospitalization episodes, adjusted for covariates. The outcome of diabetic patients in chronic hemodialysis showed high morbidity and mortality and was quite similar to that of elderly patients.
The objective was to determine the nutritional status (NS) in a population undergoing chronic hem... more The objective was to determine the nutritional status (NS) in a population undergoing chronic hemodialysis (CHD), and correlate it with dialysis dose and morbimortality. A total of 55 patients, 27 men and 28 women, aged 47 +/- 15 and with a history of CHD of 54.6 +/- 47.6 months were evaluated. NS was classified into: adequate, mild malnutrition, moderate malnutrition and severe malnutrition. A score based on usual laboratory data (total iron-binding capacity [TIBC], albumin and cholesterol), clinical evaluation and anthropometric measurements (body mass index [BMI], mid brachial circumference, tricipital fold [TF], mid brachial muscle circumference [MBMC]), was used. In addition, a 7-days' intake auto-registration plan was conducted, and protein catabolic rate (PCR) was determined. Calorie intake was of 27 +/- 13 kcal/kg/day and protein intake was of 1.2 +/- 0.5 g/kg/day. No correlation was found between the latter and PCR. 49.1% of patients had moderate to severe malnutrition, only 9 patients had an adequate NS. However anthropometric measurements showed that TF, MBMC and BMI were normal in 54.5%, 45%, and 72.7% of patients, respectively. No correlation was found between NS and age onset of CHD, sex, creatinine, dialysis dose (Kt/V x = 1.24 +/- 0.12), PCR and morbidity. A longer history of dialysis was associated with a worse NS (p < 0.01). In addition, NS significantly correlated with albumin (p < 0.01) and mortality (p < 0.05). The estimated death risk was 9.45 times higher in patients with moderate and severe malnutrition.
We investigated persistent significant proteinuria (PSP), defined as proteinuria > 1 gr/24... more We investigated persistent significant proteinuria (PSP), defined as proteinuria > 1 gr/24 hours on three consecutive months, in renal allograft recipients. The clinical records of 273 patients (288 grafts) were reviewed and 236 grafts (178 live related, 58 cadaver donor) that functioned for at least 4 months (230 patients, 148 men and 82 women) were selected for analysis. The histological diagnoses of 226 grafts and 35 native kidneys were also reviewed. PSP was present in 67 grafts (28.4%); 43 of these grafts were studied histologically (transplant glomerulopathy (TxGPT) 19, idiopathic glomerulopathy (GP) 13, and chronic rejection 11). Patients with an idiopathic GP in the graft usually presented with the nephrotic syndrome (65%); this presentation was infrequent in patients with chronic rejection. The appearance of proteinuria was strongly associated with functional deterioration in grafts with chronic rejection and TxGPT; in grafts with PSP and a histological diagnosis of idiopathic GP, renal function was usually normal. Within grafts with PSP no statistically significant differences in actuarial survival (AS) could be established when the time of appearance or magnitude of PSP, the presence or absence of arterial hypertension, the immunosuppressive regimen, and the histological diagnosis were considered. Contrariwise, the difference in AS was highly significant (p < 0.0001) when grafts with and without PSP were compared. The former had an AS at 5 and 10 years of 74.6% and 55.7%, while in the case of the latter AS was 57.3% and 32.1%, respectively. In conclusion, in the present series 28.4% of grafts that functioned 4 months or more presented PSP. The most frequent glomerular lesion was TxGPT. The presence of PSP was a marker for poorer prognosis, since AS at 5 and 10 years was significantly less in this group.
Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia
Latin America, a region composed of a series of neighboring countries that share their history, L... more Latin America, a region composed of a series of neighboring countries that share their history, Latin ancestry and language (Spanish or Portuguese), includes Mexico, Central America, the Spanish Caribbean islands, and South America. The Latin-American Dialysis and Kidney Transplantation Registry, which has been operative since 1991, collects data from 20 countries (Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Dominican Republic, Venezuela and Uruguay), where 97% of Latin Americans live. The prevalence of renal replacement therapy (RRT) has increased from 119 patients per million (pmp) in 1991 to 478.2 in 2005 (147,158 patients [57%] on chronic hemodialysis, 58,251 [23%] on peritoneal dialysis and 52,565 [20%] living with a functioning kidney graft). The incidence rate also increased from 27.8 pmp in 1992 to 167 in 2005. The increment in prevalence and incidence occurred in all Latin- American countries. The transplantation rate increased from 3,7 pmp in 1987 to 15 pmp in 2005 (7,968 kidney transplants performed this year, the cumulative number being 98,415). Access to RRT was available for every patient diagnosed with end-stage renal disease only in Argentina, Brazil, Chile, Cuba, Puerto Rico, Venezuela and Uruguay. In Latin America, the incidence and prevalence of RRT increased year by year. Only in some countries is access to RRT available to 100% of diagnosed patients. Detection and prevention programs for chronic kidney disease are needed in the region. Meanwhile, access to RRT has to be improved for everybody who needs it.
We analyzed retrospectively the outcome of 169 patients in chronic hemodialysis (CHD), divided in... more We analyzed retrospectively the outcome of 169 patients in chronic hemodialysis (CHD), divided into four groups: 1) 24 patients with diabetic nephropathy (age 53.7 +/- 11 years); 2) 19 with polycystic kidney disease (age 55.3 +/- 9 years) 3) 43 patients older than 60 when starting chronic hemodialysis with etiologies different from diabetes and polycystic kidney disease (age 69.2 +/- 5.8 years) and 4) 83 patients younger than 60 with diverse etiologies (age 42.8 +/- 12.4 years). In groups 1, 2 and 3 serum creatinine, arterial hypertension at the beginning, morbility, mortality and its causes were registered. In group 1, the prevalence of severe diabetic retinopathy and cardiovascular disease at the beginning were also analyzed. In all groups survival was determined. Of the diabetics, 92% presented severe diabetic retinopathy and 88% cardiovascular disease. The prevalence of hypertension was 100, 74 and 67% in groups 1, 2 and 3, respectively (p = 0.13). Twelve diabetics died before the first year of treatment; there was no difference in creatinine, age, cardiovascular disease, severe retinopathy and hypertension with those who lived more than one year. The percentage of time in risk hospitalized and the days/patients/year hospitalized were significantly different between group 1 and 3 and group 2 (p < 0.001). Patients were hospitalized for similar causes in groups 1 and 3: the initiation of CHD, cardiovascular and neurological diseases. The main causes of death in groups 1 and 3 were: cardiovascular disease and sudden death at home. Survival was better in group 2 compared with group 1 (p = 0.0014) but was similar between groups 1 and 3 (p = 0.21) even though there was a difference of 15 years between them. The Cox's proportional hazard model identified as risk factors diabetes, age, year of starting chronic hemodialysis and hospitalization episodes, adjusted for covariates. The outcome of diabetic patients in chronic hemodialysis showed high morbidity and mortality and was quite similar to that of elderly patients.
The objective was to determine the nutritional status (NS) in a population undergoing chronic hem... more The objective was to determine the nutritional status (NS) in a population undergoing chronic hemodialysis (CHD), and correlate it with dialysis dose and morbimortality. A total of 55 patients, 27 men and 28 women, aged 47 +/- 15 and with a history of CHD of 54.6 +/- 47.6 months were evaluated. NS was classified into: adequate, mild malnutrition, moderate malnutrition and severe malnutrition. A score based on usual laboratory data (total iron-binding capacity [TIBC], albumin and cholesterol), clinical evaluation and anthropometric measurements (body mass index [BMI], mid brachial circumference, tricipital fold [TF], mid brachial muscle circumference [MBMC]), was used. In addition, a 7-days' intake auto-registration plan was conducted, and protein catabolic rate (PCR) was determined. Calorie intake was of 27 +/- 13 kcal/kg/day and protein intake was of 1.2 +/- 0.5 g/kg/day. No correlation was found between the latter and PCR. 49.1% of patients had moderate to severe malnutrition, only 9 patients had an adequate NS. However anthropometric measurements showed that TF, MBMC and BMI were normal in 54.5%, 45%, and 72.7% of patients, respectively. No correlation was found between NS and age onset of CHD, sex, creatinine, dialysis dose (Kt/V x = 1.24 +/- 0.12), PCR and morbidity. A longer history of dialysis was associated with a worse NS (p < 0.01). In addition, NS significantly correlated with albumin (p < 0.01) and mortality (p < 0.05). The estimated death risk was 9.45 times higher in patients with moderate and severe malnutrition.
We investigated persistent significant proteinuria (PSP), defined as proteinuria > 1 gr/24... more We investigated persistent significant proteinuria (PSP), defined as proteinuria > 1 gr/24 hours on three consecutive months, in renal allograft recipients. The clinical records of 273 patients (288 grafts) were reviewed and 236 grafts (178 live related, 58 cadaver donor) that functioned for at least 4 months (230 patients, 148 men and 82 women) were selected for analysis. The histological diagnoses of 226 grafts and 35 native kidneys were also reviewed. PSP was present in 67 grafts (28.4%); 43 of these grafts were studied histologically (transplant glomerulopathy (TxGPT) 19, idiopathic glomerulopathy (GP) 13, and chronic rejection 11). Patients with an idiopathic GP in the graft usually presented with the nephrotic syndrome (65%); this presentation was infrequent in patients with chronic rejection. The appearance of proteinuria was strongly associated with functional deterioration in grafts with chronic rejection and TxGPT; in grafts with PSP and a histological diagnosis of idiopathic GP, renal function was usually normal. Within grafts with PSP no statistically significant differences in actuarial survival (AS) could be established when the time of appearance or magnitude of PSP, the presence or absence of arterial hypertension, the immunosuppressive regimen, and the histological diagnosis were considered. Contrariwise, the difference in AS was highly significant (p < 0.0001) when grafts with and without PSP were compared. The former had an AS at 5 and 10 years of 74.6% and 55.7%, while in the case of the latter AS was 57.3% and 32.1%, respectively. In conclusion, in the present series 28.4% of grafts that functioned 4 months or more presented PSP. The most frequent glomerular lesion was TxGPT. The presence of PSP was a marker for poorer prognosis, since AS at 5 and 10 years was significantly less in this group.
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