Utility of Remote Monitoring in Patients on Automated Peritoneal Dialysis

ABSTRACT Home hemodialysis (HD) and automated peritoneal dialysis (APD) have advantages over HD in hospitals or HD centers. Home therapies are generally less expensive and give patients greater mobility and freedom for work, school, family, and recreational activities. Technological advances have made it possible to complement APD with devices for remote monitoring (RM) of the patient. With them, objective information generated in the APD device is collected and sent to repositories "in the cloud" for analysis or at the time decided by the health team. With APD+RM, it is possible to monitor therapeutic compliance, effective dialysis time, ultrafiltration volumes, inflow and outflow patterns of dialysis fluid, and patient actions to respond to alarms that indicate deviations from the parameters set by the nephrologist. The results of APD+RM show good acceptance by the patient, nephrologists, and nurses, treatment adherence has improved, hospitalizations and technique failure have decreased, and some aspects of quality of life have improved. However, there is a lack of controlled clinical trials that reliably demonstrate lower mortality and comorbidity due to specific causes.

Osteoprotegerin Is a Better Predictor for Cardiovascular and All-Cause Mortality than Vascular Calcifications in a Multicenter Cohort of Patients on Peritoneal Dialysis.

The purpose of this study was to compare vascular calcification (VC), serum osteoprotegerin (OPG) levels, and other biochemical markers to determine their value as available predictors of all-cause and cardiovascular (CV) mortality in patients on peritoneal dialysis (PD). A total of 197 patients were recruited from seven dialysis centers in Mexico City. VC was assessed with multi-slice computed tomography, measured using the calcification score (CaSc). OPG, albumin, calcium, hsC-reactive protein, phosphorous, osteocalcin, total alkaline phosphatase, and intact parathormone were also analyzed. Follow-up and mortality analyses were assessed using the Cox regression model. The mean age was 43.9 ± 12.9 years, 64% were males, and 53% were diabetics. The median OPG was 11.28 (IQR: 7.6−17.4 pmol/L), and 42% of cases had cardiovascular calcifications. The median VC was 424 (IQR:101−886). During follow-up (23 ± 7 months), there were 34 deaths, and 44% were cardiovascular in origin. In multivariable analysis, OPG was a significant predictor for all-cause (HR 1.08; p < 0.002) and CV mortality (HR 1.09; p < 0.013), and performed better than VC (HR 1.00; p < 0.62 for all-cause mortality and HR 1.00; p < 0.16 for CV mortality). For each mg/dL of albumin-corrected calcium, there was an increased risk for CV mortality, and each g/dL of albumin decreased the risk factor for all-cause mortality. OPG levels above 14.37 and 13.57 pmol/L showed the highest predictive value for all-cause and CV mortality in incident PD patients and performed better than VC.

Osteoprotegerin Is the Strongest Predictor for Progression of Arterial Calcification in Peritoneal Dialysis Patients.

BACKGROUND: Arterial calcification (AC) is frequent in patients with end stage renal disease and is also considered a risk factor for later morbidity and mortality. However, long-term factors associated with the process are not well known. We analyzed the trends over time of biomarkers related with development and progression of AC in incident patients on peritoneal dialysis (PD). METHODS: We performed a prospective study with 186 patients on PD followed up for 1 year. We analyzed the progression of AC in the abdominal aorta and pelvic vessels by calcification score (CaSc), using16-cut computerized multidetector tomography at baseline and 1 year. Variables related with PD treatment, inflammation, and mineral metabolism were measured at baseline, 6, and 12 months of follow-up. Changes in biochemical variables were analyzed for their relationship with changes in AC. RESULTS: Over 1 year, the number of patients with AC increased from 47 to 56%, and CaSc from 355 (interquartile range [IQR] 75-792) to 529 (IQR 185-1632). A total of 43.5% of patients remained free of calcification, 11.7% had new calcifications, and 44.8% had progression of calcification. Older age, diabetes, high systolic blood pressure, body mass index, cholesterol, and osteoprotegerin (OPG), as well as lower levels of albumin, serum creatinine, and osteocalcin, were associated with development of new, and rapid progression of, calcification. In multivariate logistic analysis, OPG remained the most significant (OR 1.27, 95% CI 1.11-1.47, p < 0.001). CONCLUSION: OPG was the strongest risk factor associated with new development and rapid progression of AC in incident PD patients.

Impact of a comprehensive intervention to families with teenage sons with overweight and obesity in a primary care setting: A case report.

BACKGROUND: Overweight and obesity in adolescence is a public health problem and a risk factor for chronic noncommunicable diseases. To prevent further diseases, preventive interventions are needed, including educational programmes, addressed in a primary care setting, that include the whole family. The objective of this study was to evaluate the impact of a comprehensive intervention, targeting families with teenage sons with overweight and obesity, in the lifestyle, cardiovascular risk factors and metabolic syndrome in a primary care setting. METHODS: A pre-post intervention study was conducted. Twelve families with teenage sons between 10 and 14 years were enrolled; all the families were affiliated to the IMSS (Insituto Mexicano del Seguro Social). The comprehensive strategy was applied for 6 months (educational sessions for self-care, physical activity and nutritional counselling). The following measurements were performed before and after the intervention: the FANTASTIC lifestyle survey was applied. Clinical, anthropometric and biochemical assessments were performed. The changes in life style and cardiovascular risk factors were analyzed with Student's t-test or Mann-Whitney U test. RESULTS: The lifestyle was improved after the intervention in the domains of family and friends, nutrition and alcohol intake (p<0.05). Body mass index, waist circumference and diastolic blood pressure and fasting glucose decreased significantly. CHDL increased (p<0.05). Metabolic syndrome improved (p<0.05). CONCLUSIONS: Our comprehensive intervention for the families in a primary care setting, improved their lifestyle, decreased cardiovascular risk factors and decreased the metabolic syndrome.

[Network Research on Human Papillomavirus]. / Red de Investigación en Virus del Papiloma Humano.

In order to increase the research in important health questions at a national and institutional levels, the Human Papillomavirus Research Network of the Health Research Coordination of the Instituto Mexicano del Seguro Social offers this supplement with the purpose of assisting patients that daily look for attention due to the human papillomavirus or to cervical cancer.

A fin de incrementar la investigación en temas prioritarios de salud a nivel nacional e institucional, la Red de Investigación del Virus del Papiloma Humano de la Coordinación de Investigación en Salud del Instituto Mexicano del Seguro Social ofrece este suplemento con el objetivo de beneficiar a las pacientes que día a día se atienden por el virus de papiloma humano o por el cáncer cervicouterino.

De novo development of heart valve calcification in incident peritoneal dialysis patients.

BACKGROUND AND AIMS: Cardiac valve calcification (VC) is a frequent complication in chronic kidney disease and is considered a risk factor for all-cause and cardiovascular mortality. However, little is known about the pathophysiology mechanisms that originate it and the factors associated with its development. We undertook this study to analyze the frequency and factors related to de novo development of mitral valve calcification (MVC) and aortic valve calcifications (AVC) in incident peritoneal dialysis (PD) patients. METHODS: A prospective cohort of 124 incident PD patients was studied. Demographic and clinical data were recorded and blood assayed at baseline and after 1 year of follow-up for calcium, phosphorus, glucose, urea, creatinine, cholesterol, triglycerides by spectrophotometry assay; high-sensitivity C-reactive protein (CRP) by immunoturbidimetric ultrasensitive assay, intact parathormone (iPTH) and osteocalcin by electrochemiluminescence, fetuin-A and osteoprotegerin by EDI-ELISA. Valve calcification was evaluated by M-mode bidimensional echocardiogram. RESULTS: Sixty eight percent of patients were male, ages 43 ± 13 years; 51% were diabetic with 1.4 ± 1 months on PD. After 12.3 ± 1 months, 57 patients (46%) developed VC: AVC in 33 (57.8%), MVC in 15 (26.3%) and 9 (15.8%) patients in both valves. There was no correlation between AVC and MCV. In univariate logistic regression analysis, age, diabetes and elevated concentrations of OPG, iPTH and CRP were risk factors for development MVC. In multivariate analysis, only iPTH remained an independent risk factor as was also the case in AVC. CONCLUSIONS: Age, diabetes, osteoprotegerin, parathormone and C-reactive protein are risk factors related to de novo development of MVC and iPTH for AVC in incident dialysis patients.

Cardiovascular and renal effects of bromocriptine in diabetic patients with stage 4 chronic kidney disease.

OBJECTIVE: The objective of this study was to investigate the effect of bromocriptine (BEC) on left ventricular mass index (LVMI) and residual renal function (RRF) in chronic kidney disease (CKD) patients with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: A 6-month double-blind randomized controlled trial was conducted in 28 patients with T2D and stage 4 CKD with increased LVMI. Fourteen patients received BEC (2.5 mg, initially 1 tablet with subsequent increase to three times a day) and 14 received a placebo (PBO; initially 1 tablet with subsequent increase to three times a day). Cardiovascular changes were assessed by monitoring 24 h ambulatory blood pressure, two-dimensional-guided M-mode echocardiography, and N-terminal brain natriuretic peptide (NT-proBNP) plasma levels. RRF was evaluated by creatinine clearance and cystatin-C plasma levels. RESULTS: Both BEC and PBO groups decreased blood pressure-but the effect was more pronounced in the BEC group. Average 24 h, diurnal and nocturnal blood pressures, and circadian profile showed improved values compared to the PBO group; LVMI decreased by 14% in BEC and increased by 8% in PBO group. NT-proBNP decreased in BEC (0.54 ± 0.15 to 0.32 ± 0.17 pg/mL) and increased in PBO (0.37 ± 0.15 to 0.64 ± 0.17 pg/mL). Creatinine clearance did not change in the BEC group and decreased in the PBO group. CONCLUSIONS: BEC resulted in a decrease on blood pressure and LVMI. BEC also prevented the progression of CKD while maintaining the creatinine clearance unchanged.

La problemáticas psicosociales en Medellín: una reflexión desde las experiencias institucionales / Psychosocal problems in Medellín: reflection around institutional experiences

Las reflexiones en torno a las experiencias de intervención psicosocial, organizadas por la Mesa de Salud Mental de la Facultad Nacional de Salud Pública de la Universidad de Antioquia durante los años 2003 y 2004, y en la cual participaron 93 organizaciones e instituciones de naturaleza pública y privada, adscritas a los sectores educativo, social-comunitario, salud y eclesiástico, permitieron conocer y comprender los conceptos de intervención psicosocial, los fundamentos teóricos, los enfoques de trabajo y problemas priorizados sobre los que fundamentaron el trabajo psicosocial. La metodología cualitativa del estudio, se orientó bajo un enfoque hermenéutico, transcribiendo y analizando los relatos obtenidos en los grupos focales de cinco seminarios taller.

The reflections around the experiences of psychosocial intervention, organized by the working of Mental Health of the University of Antioquia during the years 2003 and 2004, with 93 organizations and institutions of public and private nature, attributed to the educational, social and community, health and ecclesiastical sectors, they allowed to know and to understand the concepts of the psychosocial intervention, the theoretical foundations, the work focuses and problems prioritized on those that base the work psychosocial. The qualitative methodology of the study, was guided under a hermeneutic focus, transcribing and analyzing the stories under a ned in the focal groups of five seminars-workshop.

Colonización por Staphylococcus aureus y riesgo de desarrollar episodio de peritonitis causado por cepa idéntica en pacientes pediátricos en diálisis peritoneal continua ambulatoria / Staphylococcus aureus colonization and risk of developing a subsequent peritonitis episode caused by an identical strain, among pediatric patients admitted for continuous ambulatory peritoneal dialysis

Objetivo: Determinar el riesgo de los pacientes pediátricos con insuficiencia renal crónica terminal en programa de diálisis peritoneal continua ambulatoria (DPCA), portadores de Staphylococcus aureus (SA) en nariz, manos o sitio de salida del catéter, para desarrollar episodio de peritonitis causado por una cepa idéntica. Métodos: Estudio longitudinal en un centro de DPCA perteneciente a un hospital pediátrico de tercer nivel. Al ingresar al estudio se tomaron cultivos de las narinas, sitio de salida del catéter y manos, de 29 pacientes vigilados por un periodo promedio de 369 ± 80 días (de 224 a 516 días), y de las narinas y manos de sus madres. Las cepas de SA aisladas se conservaron en glicerol BHI a –20°C para análisis posterior. Los episodios de peritonitis se monitorearon y registraron. Cuando se aisló una cepa de SA del líquido de diálisis efluente se comparó con la previa identificada por electroforesis en gel de campos pulsados. Resultados: Se presentaron siete episodios de peritonitis causados por SA en seis pacientes, uno de los cuales era portador previo de la misma cepa en la nariz y dos en el sitio de salida del catéter. El riesgo relativo de desarrollar un episodio de peritonitis causado por una cepa preexistente localizada en el sitio de salida del catéter fue de 0.948, y de 0.525 por una cepa preexistente localizada en la nariz. Conclusiones: Los portadores de SA no parecen tener riesgo más alto de desarrollar peritonitis causada por una cepa de SA relacionada que los no portadores. No se sustenta la recomendación de monitorear el estado de portador nasal o en el sitio de salida del catéter en los pacientes tratados con DPCA. La conveniencia de erradicar el SA de la nariz o el sitio de salida del catéter también es cuestionable.

OBJECTIVE: To determine the risk of pediatric end stage renal disease patients undergoing continuous ambulatory peritoneal dialysis to develop a subsecuent peritonitis episode caused by an identical Staphylococcus aureus (SA) strain. METHODS: Longitudinal survey carried out in a CAPD center at the nephrology department of a tertiary care (reference) pediatric hospital. At recruitment, swabs were collected from the nares, exit site, and hands, respectively from 29 patients who were followed-up for a mean period of 369 +/- 80 days (range 224-516 days), and from the nares and hands of their mothers. Isolated SA strains were kept in BHI glycerol at -20 degrees C for subsequent analysis. Peritonitis episodes were monitored and registered. When a SA strain was isolated from the dialysate effluent it was compared with the preexisting strain by PFGE. RESULTS: We report 7 SA-mediated peritonitis episodes among 6 patients. Only one of these patients was a previous nasal carrier, and 2 were previous exit site carriers of the same SA strain. The relative risk of developing a peritonitis episode caused by a preexistent SA strain colonizing the exit site was 0.948. The relative risk of developing a peritonitis episode caused by a preexistent SA strain colonizing the nares was 0.525. CONCLUSIONS: SA carriers do not appear to be at higher risk of developing peritonitis by an SA related strain than non-carriers. Our results do not lend support to the recommendation of monitoring nasal or exit site carrier status in CAPD patients. The need of attempting to eradicate SA from nose or exit site is also questioned.

Inflammation and oxidative stress markers by pentoxifylline treatment in rats with chronic renal failure and high sodium intake.

BACKGROUND: Inflammation is a risk factor for mortality in patients with chronic renal failure (CRF). Prevention of extracellular fluid volume expansion and the use of certain drugs such as pentoxifylline (PF) may reduce inflammation and oxidative stress. The aim of this study is to analyze the effect of dietary sodium and PF treatment on the levels of inflammation and oxidative stress markers in rats with CRF. METHODS: CRF was induced in rats by 5/6 nephrectomy. Different groups of rats with CRF received low sodium (LNa, 0.01% sodium chloride [NaCl] in the diet), normal sodium (NNa, 0.05% NaCl in the diet), or high sodium diet (HNa, as in NNa plus 0.015% NaCl in the drinking water). An additional group received HNa plus PF treatment (25 mg/kg in the drinking water) for 60 days. Circulating creatinine, tumor necrosis factor alpha (TNF-alpha), nitrites, thiols, malondialdehyde (MDA), and advanced oxidation protein products (AOPP) were measured. RESULTS: Higher sodium intake was associated with higher serum creatinine levels (median; interquartile range), LNa, 1.255; 0.715, NNa, 1.305; 0.495, HNa, 2.015; 1.115 mg/dL (p < 0.05), TNF-alpha levels, LNa, 2.7; 23.6, NNa, 36.7; 47.7, HNa, 263.7; 126.5 pg/mL, and AOPP, LNa, 31.72; 7.55, NNa, 45.89; 9.38, HNa, 60.41; 37.42 microg/mL. MDA was not modified by sodium intake. PF treatment decreased serum TNF-alpha (151.7 pg/mL, p < 0.5) and AOPP (49.83 micromol/L, p < 0.03), and increased nitrites and thiols levels when compared with HNa rats. CONCLUSIONS: High sodium intake increases the serum concentration of inflammation and oxidative stress markers; these changes are prevented by PF treatment.

Prevalence of chronic kidney disease in an urban Mexican population.

BACKGROUND: The present study was primarily designed to assess the prevalence of chronic kidney disease in a Mexican urban population residing in Mexico and to evaluate certain biologic and socioeconomic conditions as risk factors for the development of renal disease. METHODS: A population-based cross-sectional survey was conducted, which included 3564 patients of either gender aged >18 years, who were randomly selected from lists of patients assigned to primary care facilities in the city of Morelia. A questionnaire about personal current health status, kidney disease, diabetes, hypertension, or heart disease in close relatives, anthropometric and blood pressure measurements, and blood and urine samples to measure glucose, blood urea nitrogen, and creatinine was obtained for each patient. Creatinine clearance (Ccr) was calculated by the Cockcroft-Gault formula. Patients were classified in 1 of the 5 Ccr categories established by the Kidney Disease Outcomes Quality Initiative guidelines. RESULTS: The prevalence rate of Ccr < 15 mL/min was 1142 per million population, and that of Ccr <60 mL/min 80,788 per million population. Alcohol and tobacco consumption, female gender, age >65 years, educational level < primary school, and income < US $4.00/day were significantly associated with reduced Ccr. CONCLUSION: Chronic kidney disease prevalence in this population is similar to that seen in industrialized countries. If these figures are similar to those of the entire Mexican population, only l out of 4 patients requiring renal replacement therapy in the country currently has access to it.

Impact of fill volume on peritoneal clearances and cytokine appearance in peritoneal dialysis.

BACKGROUND: Current adequacy guidelines for peritoneal dialysis encourage the use of large fill volumes for the attainment of small solute clearance targets. These guidelines have influenced clinical practice in a significant way, and adoption of higher fill volumes has become common in North America. Several studies, however, have challenged the relevance of increasing small solute clearance; this practice may result in untoward consequences in patients. OBJECTIVE: The present study was designed to explore the relationship between dialysate volume and the clearance of different sized molecules, fluid dynamics, and appearance of peritoneal cytokines. METHODS: Thirteen adult prevalent patients on continuous ambulatory peritoneal dialysis were studied. Three different dialysate volumes (2.0, 2.5, and 3.0 L) were infused on consecutive days in a random order. Several measurements of peritoneal fluid dynamics (intraperitoneal pressure, net ultrafiltration, fluid absorption), solute clearances (urea, creatinine, beta2-microglobulin, albumin, IgG, and transferrin), and appearance of interleukin-6 and tumor necrosis factor alpha (TNFalpha) were assessed. RESULTS: Increase in dialysate fill volume (from 2 to 2.5 to 3 L) was examined in relationship to body surface area (BSA). The dialysate volume/BSA (DV/BSA) ratio increased from 1262 to 1566 to 1871 mL/m2 on 2.0, 2.5, and 3.0 L dialysate volumes, respectively. In parallel, diastolic blood pressure increased from 82.7 +/- 8.8 to 87.0 +/- 9.5 to 92 +/- 8.3 mmHg (p < 0.05). Net ultrafiltration rate also increased, from 0.46 +/- 0.48 to 0.72 +/- 0.42 to 0.97 +/- 0.49 mL/minute (p < 0.01), despite a concomitant increase in fluid absorption, from 1.05 +/- 0.34 to 1.21 +/- 0.40 to 1.56 +/- 0.22 mL/min (p < 0.01). Urea peritoneal clearance increased from 8.27 +/- 0.68 to 9.92 +/- 1.6 to 12.98 +/- 4.03 mL/min (p < 0.01); creatinine peritoneal clearance increased from 6.69 +/- 1.01 to 7.64 +/- 1.12 to 8.69 +/- 1.76 mL/min (p < 0.01). Clearance of the other measured molecules did not change. Appearance of interleukin-6 increased 17% and 43% (p < 0.01), and TNFalpha appearance increased 14% and 50% (p < 0.01) when dialysate volumes of 2.5 and 3.0 L were used, compared with 2.0 L. CONCLUSIONS: These results show that, with higher values of DV/BSA ratio, small solute peritoneal clearance is increased, but clearances of large molecules remain unchanged. With the use of higher volumes, fluid absorption rate and the appearance of proinflammatory cytokines in the dialysate are increased.

Acute effects of soft drink intake on calcium and phosphate metabolism in immature and adult rats

Objetivo. Probar los efectos de la ingestión aguda de un refresco de cola que contiene ácido fosfórico sobre el metabolismo ácido-base y de calcio y fosfatos. Material y métodos: Se estudiaron 14 ratas adultas de 90 días de edad de la cepa Sprague Dawley y 14 inmaduras de 30 días de edad. Aleatoriamente se asignaron siete animales de cada grupo para recibir sólo agua (grupos control) o Coca-Cola ad libitum durante siete días. Después los animales se colocaron individualmente en jaulas metabólicas para colectar orina de 24 hrs. Los animales se exsanguinaron por punción directa de la arteria aorta y se midió pH y calcio en sangre total. Se midieron niveles plasmáticos de PTH, 1Ó, 25 (OH)2 D3 y 25 OH d3 con estuches comerciales de IRMA y RIA y plasmáticos y urinarios de creatinina, fosfatos y calcio. Resultados. En ambos grupos, los animales que recibieron refresco desarrollaron hipercalciuria e hiperfosfaturia. En los animales inmaduros el pH disminuyó de 7.45 ñ 0.04 a 7.33 ñ 0.02 (p< 0.05) pero co cambió en los animales adultos. En los animales inmaduros el calcio ionizado disminuyó significativamente de 1.06 ñ 0.04 a 0.80 ñ 0.06 meq/l(p < 0.05), pero no en los adultos, Sólo los animales adultos desarrollaron hiperparatiroidismo significativo. Los animales inmaduros mostraron trastornos más graves del metabolismo del calcio y fosfato relacionados con la ingestion de refrescos de cola

Los refrescos y la salud / Soft drinks and health

Objetivo. Analizar los artículos publicados sobre consumo de refrescos y describir los posibles beneficios, riesgos y daño a la salud relacionados con él. Fuente de información. Se realizó búsqueda y revisión en el sistema de discos compactos MEDLINE de enero de 1970 a enero de 1997 con las palabras soft drink, beverages, carbonated beverages, cola, Coca-Cola y sweetening-agents. Selección de estudios. Se revisaron 99 estudios en los que se describen daños o beneficios para la salud en estudios clínicos o experimentales. Extracción de los datos. Se consideraron todos los artículos en que se describió con claridad al menos un efecto benéfico o dañino relacionado con el consumo de refrescos. Resultados. Se identificarón 25 efectos dañinos y 7 efectos posiblemente benéficos. Los datos se clasifican en usos profilácticos y terapéuticos, caries dental y otros trastornos de los dientes, trastornos del metabolismo de los minerales, enfermedad ácido péptica, neoplasias, factores de riesgo para enfermedad cardiovascular, efectos sobre el sistema nervioso central, reproducción, alergia, contaminantes y misceláneos. Conclusiones. La alta prevalancia de exposición y el consumo excesivo de refrescos, pueden representar un problema de salud pública en México. El análisis de los datos muestra que el consumo de refresco puede no ser tan inocuo como generalmente se cree. Muchos de los informes son anecdóticos, sin diseño metodológico adecuado. Se identifica un campo de investigación amplio en esta área

Alteraciones en el metabolismo del calcio y fosfato secundarias a la ingestión de refrescos fosforados / Calcium and phosphate metabolism disorders secondary to consumption of soft drinks with phosphoric acid

Introducción. El objetivo de este trabajo es describir la asociación de ingestión de refrescos con ácido fosfórico e hipocalcemia. Material y Métodos. Se presentan los casos clínicos de cinco niños con el antecedente de ingerir al menos una botella de refresco con ácido fosfórico al día, que acudieron a consulta por diversas manifestaciones clínicas de hipocalcemia como sobresaltos nocturnos, convulsiones o espasmo del sollozo, y una serie de casos de 43 niños con antecedente de ingestión de al menos cuatro botellas de refresco a la semana. Resultados. En los cinco casos clínicos descritos, al suspender la ingestión de refrescos desaparecieron las manifestaciones clínicas de hipocalcemia y en todos los casos aumentó la calcemia y disminuyó la fosfatemia. En la serie de casos, 18 de los 43 (41.9 por ciento) niños estudiados tenían hipocalcemia con valores inferiores a 2.20 mmol/L(8.8 mg/dL). No se encontraron referencias en la literatura sobre esta asociación. Conclusiones. Los datos presentados hacen surgir la hipótesis de una posible relación causal entre la ingestión de refrescos y los trastornos del metabolismo de calcio y fosfato. Refrescos; cola; ácido fosfórico; hipocalcemia; hiperfosfatemia

Bone mineral content, 25-hydroxycalciferol and zinc serum levels in insulin-dependent (Type I) diabetic patients

Se estudiaron 22 pacientes diabéticos insulino-dependientes en mal control metabólico, para determinar si existe relación entre el contenido mineral óseo (BMC) y la concentración de 2a5-hidroxicalciferon (25OHD) y de zinc. El contenido mineral óseo se determinó mediante un procedimiento de absorción de fotones en el tercio distal del antebrazo derecho; zinc, 25OHD y la fosfatasa alcalina se mideron en suero, y calcio, fosfatos, magnesio, glucosa y AMPc se determinaron tanto en plasma como en orina de 24 hrs. Los pacientes diabéticos mostraron menor contenido mineral óseo (p<0.001), y excreción urinaria mayor de calcio (p<0.001) que los testigos. Por otra parte, las concentraciones de zinc y 25 OHD en el suero fueron significativamente menores que en los testigos (p<0.001). Se encontraron correlaciones significativas entre glucosuria y excreción urinaria de calcio (r= 0.77; p<0.001), así como entre concentración de 25OHD y la excreción urinaria de calcio (r=0.77; p<0.001). Estos resultados sugieren que en pacientes con diabetes mellitus tipo I en mal control metabólico, las concentraciones de zinc y 2a5ODH bajas así como el aumento de la excreción urinaria de calcio, secundaria a diuresis osmótica, contribuyen a la reducción del contenido mineral óseo en estos pacientes

Valoración comparativa del efecto antihipertensivo y metabólico de la combinación de hidroclorotiacida y amilorida, y de la clortalidona sola y con sales de potasio en pacientes con hipertensión arterial esencial / Antihypertesive and metabolic effect of hidrochlorothiazide-amiloride combination and chlorthalidone alone and with potassium salts in patients with essential hypertension

En 20 pacientes con hipertensión arterial esencial leve a moderada se valoró en forma comparativa el efecto antihipertensivo y metabólico de una combinación de 50 mg de hidroclorotiacida con 5 mg de amilorida con el obtenido tras la administración de clorotalidona sola y agregado sales de potasio por vía oral. Cada grupo se formó de 10 enfermos que recibieron indistintamente uno de los medicamentos durante tres meses. Al final del estudio se observó una disminución similar en la tensión arterial media en ambos grupos, con promedio de 25 mm Hg. Sin embargo, los pacientes que recibieron clorotalidona desarrollaron alcalosis y disminución sérica (4.6 + 0.1 a 3.5 + 0.1 mEg/L, p 0.01) e intraglobular de potasio (98 + 1 a 86 + 1.1 mEq/L, p 0.001). La administración oral de sales de potasio sólo originó incremento en la eliminación renal del electrólito, sin modificación del potasio en el suero o en el eritrocito. Los pacientes que recibieron hidroclorotiacida más amilorida no mostraron alteración electrolítica, lo que pone de manifiesto la eficiencia de la amilorida para prevenir esos efectos indeseables de los diuréticos tiacídicos