RESUMO
OBJECTIVE: Percutaneous transluminal coronary angioplasty (PTCA) in patients on maintenance hemodialysis leads to high rates of restenosis and postinterventional complications. The additional influence of diabetes mellitus on the results of PTCA in patients with diabetic nephropathy and reduced but sufficient renal function has not been investigated before. METHODS: In a retrospective case-control study, 51 patients with reduced renal function were compared to 71 matched controls. Patients with elevated creatinine values were divided in two subgroups: diabetic nephropathy (diabetes, n = 15) and stable renal insufficiency (renal failure, n = 36). RESULTS: The control group had normal renal function (creatinine: 1.0 +/- 0.01) and a mean survival time of 3.6 +/- 0.8 years. Patients with renal failure showed a mean survival time of 2.7 +/- 0.3 years (p < 0.001), creatinine values of 2.0 +/- 0.2 and elevated fibrinogen values of 401 +/- 28 (p < 0.01). Patients with diabetes (creatinine: 2.2 +/- 0.2) had a significantly higher mortality rate with a reduced mean survival time of 1.25 +/- 0.3 years (p < 0.001), postinterventional acute renal failure (n = 2, p < 0.01) and Re-PTCA (n = 2, p < 0.05). DISCUSSION: Patients with reduced but stable renal function showed a higher mortality than comparable patients from the control group. The group of patients with diabetic nephropathy has a poor prognosis after PTCA even though renal function was only moderately reduced.
Assuntos
Angioplastia Coronária com Balão , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/terapia , Nefropatias Diabéticas/mortalidade , Falência Renal Crônica/mortalidade , Idoso , Estudos de Casos e Controles , Reestenose Coronária/mortalidade , Nefropatias Diabéticas/terapia , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Complicações Pós-Operatórias/mortalidade , Prognóstico , Modelos de Riscos Proporcionais , Diálise Renal , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the influence of different membrane materials on the efficiency of iopromide elimination. MATERIAL AND METHODS: Twenty stable patients with chronic renal failure after coronary angiography were investigated for contrast medium elimination during hemodialysis directly after contrast medium application. RESULTS: Clearance during hemodialysis with cuprophan membranes was 102 +/- 7 mg/ml in contrast to 153 +/- 4 mg/ml in polysulfone membranes. Elimination half-time was 94 +/- 5 min in cuprophan and 79 +/- 3 min in polysulfone membranes, and the elimination rate after 120 min was 59 +/- 2% and 66 +/- 1.5% respectively. Plasma clearance of iopromide was elevated in polysulfone membranes (188 +/-17 ml/min); however, not significantly different to cuprophane membranes (153 +/-11 ml/min). Accordingly, 24-h urinary iopromide excretion was reduced to 26 +/- 4 g/24 h vs. 32 +/- 7 g/24 h. CONCLUSION: Hemodialysis for iopromide elimination with polysulfone membranes is more effective than with cuprophan membranes.
Assuntos
Celulose/análogos & derivados , Meios de Contraste/farmacocinética , Iohexol/análogos & derivados , Iohexol/farmacocinética , Membranas Artificiais , Diálise Renal , Humanos , Falência Renal Crônica/metabolismo , Falência Renal Crônica/terapia , Polímeros , SulfonasRESUMO
Haemodialysis for the elimination of contrast medium in patients with advanced renal failure is a common procedure. Even though sufficient elimination with the use of regular low-flux membranes is documented, large differences in results have been reported in prior investigations. We, therefore, compared Cuprophan and polysulfone dialysers with different surface areas to haemofiltration with different amounts of substitution fluid in 40 patients with compromised renal function after coronary angiography. Plasma iodine concentrations were measured by fluorescent excitation analysis. At constant blood flow rates of 200 ml/min, Cuprophan membranes with 1. 3 m(2) surface area had a clearance rate of 87 ml/min, whereas polysulfone membranes of comparable size displayed a significantly higher clearance rate of 147 ml/min. Polysulfone membranes with 1.8 m(2) surface area showed a small but insignificant increase in the iodine clearance (162 ml/min), while Cuprophan membranes displayed an increase in clearance rates (121 ml/min). Additional ultrafiltration led to a further increase in the plasma clearance of both membranes and reduced urinary iodine excretion. Haemofiltration was comparable to haemodialysis in terms of efficacy and thus represents an alternative method. Clearance of iopromide during haemodialysis with polysulfone membranes is higher than with Cuprophan membranes. Elimination rates can be further increased by additional ultrafiltration. Haemofiltration is comparable to haemodialysis regarding contrast medium elimination.
Assuntos
Materiais Biocompatíveis , Celulose/análogos & derivados , Meios de Contraste/farmacocinética , Iohexol/análogos & derivados , Iohexol/farmacocinética , Rim/fisiopatologia , Membranas Artificiais , Polímeros , Diálise Renal/instrumentação , Diálise Renal/métodos , Sulfonas , Angiografia Coronária , Taxa de Filtração Glomerular , Humanos , Iodo/sangue , Propriedades de Superfície , Fatores de TempoAssuntos
Anemia Hipocrômica/diagnóstico , Infecções por HIV/sangue , Deficiências de Ferro , Adulto , Anemia Hipocrômica/sangue , Anemia Hipocrômica/tratamento farmacológico , Biomarcadores , Eritropoetina/uso terapêutico , Feminino , Ferritinas/metabolismo , Infecções por HIV/complicações , Humanos , Ferro/sangue , Ferro/farmacocinética , Masculino , Valor Preditivo dos Testes , Protoporfirinas/sangue , Receptores da Transferrina/metabolismo , Proteínas Recombinantes , Sensibilidade e Especificidade , Transferrina/metabolismoRESUMO
Hepatitis G virus (HGV) is a newly described RNA virus from the family of flaviviridae. It is closely related to the hepatitis C Virus (HCV) but is more common than HCV among healthy blood donors. The pathogenicity of HGV in immunosuppressed patients such as those undergoing hemodialysis is unclear. We measured the incidence of HGV in 105 patients undergoing hemodialysis in a chronic outpatient hemodialysis facility. HGV-RNA was detected using a RT-PCR method with primers directed against the 5' non-coding region and the NS5a gene of HGV. Nine (8.6%) patients were HGV RNA positive, eleven (10.5%) were anti-HCV positive, three (2.9%) were positive for hepatitis B surface antigen. Four patients were positive for both HGV and HCV; three of them had normal liver enzymes while one showed elevated ALT levels but no other signs of exacerbation of preexisting hepatitis. The prevalence of HGV among dialysis patients is comparable to that of HCV. The transmission route for HCV is nosocomial transmission during dialysis, whereas HGV shows both ways of transmission: blood transfusion mediated by a high prevalence of HGV among healthy blood donors and nosocomial transmission. HGV appears to play a minor role in acute hepatitis, even in immunosuppressed patients.
Assuntos
Flaviviridae/genética , Diálise Renal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Instituições de Assistência Ambulatorial/normas , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/virologia , Europa (Continente) , Feminino , Antígenos do Núcleo do Vírus da Hepatite B/sangue , Anticorpos Anti-Hepatite C/sangue , Hepatite Viral Humana/epidemiologia , Hepatite Viral Humana/transmissão , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , RNA/sangue , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Reação TransfusionalAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Transplante de Rim/efeitos adversos , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/tratamento farmacológico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/farmacocinética , Anuria/fisiopatologia , Cisplatino/administração & dosagem , Cisplatino/farmacocinética , Doxorrubicina/administração & dosagem , Doxorrubicina/farmacocinética , Humanos , Transplante de Rim/fisiologia , Metástase Linfática , Masculino , Metotrexato/administração & dosagem , Metotrexato/farmacocinética , Recidiva , Vimblastina/administração & dosagem , Vimblastina/farmacocinéticaRESUMO
The influence of fluvastatin, a liver-selective, competitive inhibitor of the 3-hydroxymethyl-glutaryl-coenzyme A reductase, on the lipoprotein metabolism was investigated in 9 patients with nephrotic syndrome. All patients had biopsy-proven renal disease as cause of their nephrotic syndrome and exhibited severe hyperlipidemia [baseline: serum cholesterol 358 +/- 46 mg/dl (9.3 mmol/l), low-density lipoprotein cholesterol 236 +/- 18 mg/dl (6.1 mmol/l), triglycerides 333 +/- 28 mg/dl (3.8 mmol/l), and lipoprotein Lp(a) 46 +/- 11 mg/dl]. After 1 year of 40 mg of fluvastatin, significant reductions of total cholesterol by 31% to 242 +/- 26 mg/dl (6.3 mmol/l) and low-density lipoprotein cholesterol by 29% to 162 +/- 12 mg/dl (4.2 mmol/l) were observed. Furthermore, triglyceride values were also lowered significantly by 19% to 268 +/- 21 mg/dl (3.1 mmol/l). Lipoprotein Lp(a) and high-density lipoprotein-cholesterol remained unchanged by fluvastatin. These improvements in lipid profile were maintained during the entire follow-up period of 1 year. There were no adverse events, and the slight increase in serum creatinine observed during the study was considered to be due to the primary renal disease. In conclusion, long- term administration of fluvastatin in patients with nephrotic syndrome appears to be an effective and safe treatment of the hyperlipidemia associated with this disorder.
Assuntos
Ácidos Graxos Monoinsaturados/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipidemias/tratamento farmacológico , Indóis/uso terapêutico , Síndrome Nefrótica/complicações , Adulto , Colesterol/sangue , Fluvastatina , Seguimentos , Humanos , Hipercolesterolemia/complicações , Hipercolesterolemia/tratamento farmacológico , Hiperlipidemias/complicações , Estudos Prospectivos , Fatores de TempoRESUMO
PURPOSE: The present clinical trial addressed the clearance of the contrast medium iopromide, a middle-sized molecule, during dialysis with high- and low-flux membranes. MATERIAL AND METHODS: Twenty chronic haemodialysis patients without residual renal function were dialysed either with low-flux haemophan or high-flux polyamide directly after application of the contrast medium. Iodine concentrations were determined by radiofluorescence methods. RESULTS: Plasma concentrations of iodine before dialysis ranged between 1.1 and 3.9 mg/ml. The mean clearance rates for both membranes were comparable (110+/-1.4 ml/min high-flux and 108+/-1.9 ml/min low-flux), the sieving-coefficient was 0.83 for both membranes. After three hours of dialysis, 58% (high-flux) and 62% (low-flux) of iopromide was removed, half time of elimination was reached after 140+/-16 min (high-flux) and 122+/-11 min (low-flux). CONCLUSION: Our results demonstrated that elimination of iopromide is not dependent on the pore size of the membrane during dialysis. Due to higher blood flow rate, we found a higher elimination rate and a reduced half-time of elimination than prior investigations.
Assuntos
Meios de Contraste/farmacocinética , Iohexol/análogos & derivados , Membranas Artificiais , Diálise Renal/instrumentação , Humanos , Iohexol/farmacocinética , Pessoa de Meia-IdadeRESUMO
BACKGROUND: We assessed zinc protoporphyrin (ZPP) and the percentage of hypochromic erythrocytes in patients with advanced acquired immunodeficiency syndrome (AIDS) treated with recombinant erythropoietin (rhEPO). METHODS: Patients received 150 IU rhEPO subcutaneously every second day for 10 days, and 150 IU rhEPO plus 62.5 mg of intravenous iron every second day for an additional 10 days. RESULTS: Before rhEPO therapy, ZPP was at 64.3 +/- 27.3 micromol/mol heme and the percentage of hypochromic erythrocytes was elevated at 9.7%, indicating mild functional iron deficiency. Ferritin was 1,002 +/- 956 microg/L, with transferrin saturation of 19.1 +/- 9.7%. Under rhEPO alone, ZPP rose to 80.1 +/- 21.6 micromol/mol heme and the percentage of hypochromic red cells rose to 22.9 +/- 4.7%; ferritin fell to 705 +/- 601 microg/L and transferrin saturation fell to 12 +/- 6.3%. When rhEPO was supplemented with iron, ZPP fell to 70.4 +/- 20.5 micromol/mol heme, the percentage of hypochromic red cells fell to 14.7 +/- 3.4%; ferritin was unchanged at 771 +/- 62 microg/L and transferrin saturation rose to 20.5 +/- 5.5%. CONCLUSIONS: In contrast to ferritin and transferrin saturation, ZPP and the percentage of hypochromic erythrocytes effectively detect the functional iron deficiency under rhEPO therapy in advanced AIDS.