ABSTRACT
BACKGROUND: Hypertension is a leading cause of kidney failure, affects most dialysis patients and associates with adverse outcomes. Hypertension can be difficult to control with dialysis modalities having differential effects on sodium and water removal. There are two main types of peritoneal dialysis (PD), automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). It is unknown whether one is superior to the other in controlling blood pressure (BP). Therefore, the aim of our study was to analyse the impact of switching between these two PD modalities on BP levels in a nationally representative cohort. METHODS: This was a cohort study of patients on PD from 122 dialysis centres in Brazil (BRAZPD II study). Clinical and laboratory data were collected monthly throughout the study duration. We selected all patients who remained on PD at least 6 months and 3 months on each modality at minimum. We compared the changes in mean systolic/diastolic blood pressures (SBP/DBP) before and after modality transition using a multilevel mixed-model where patients were at first level and their clinics at the second level. RESULTS: We analysed data of 848 patients (814 starting on CAPD and 34 starting on APD). The SBP decreased by 4 (SD 22) mmHg when transitioning from CAPD to APD (p < 0.001) and increased by 4 (SD 21) mmHg when transitioning from APD to CAPD (p = 0.38); consistent findings were seen for DBP. There was no significant change in the number of antihypertensive drugs prescribed before and after transition. CONCLUSIONS: Transition between PD modalities seems to directly impact on BP levels. Further studies are needed to confirm if switching to APD could be an effective treatment for uncontrolled hypertension among CAPD patients.
ABSTRACT
PURPOSE: The purpose of this study was to demonstrate the association between benign rolandic epilepsy of childhood (BREC) and central auditory processing disorders (CAPDs) and to test the hypothesis that an early onset of BREC could be associated with more cases of CAPD. METHOD: This study has a retrospective cross-sectional design conducted from January 2006 to January 2016 including 93 patients with BREC and without intellectual disability, dyslexia, and attention-deficit hyperactivity disorders. All patients were evaluated for central auditory processing (CAP), and its presence or absence was compared with age of seizure onset. RESULTS: In all patients, audiometric test results were normal, and in 43 cases (46.2%), CAPD was detected. There was no significant statistical difference in the mean age of seizure onset. CONCLUSION: A significant proportion of children with BREC will have a diagnosis of CAPD at school age.
Subject(s)
Epilepsy, Rolandic/complications , Language Development Disorders/complications , Attention Deficit Disorder with Hyperactivity/complications , Brazil/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Electroencephalography , Female , Humans , Language Development Disorders/epidemiology , Male , Prevalence , Retrospective Studies , Seizures/complicationsABSTRACT
El riesgo de adquirir hepatitis B en pacientes con insuficiencia renal crónica depende del tipo y duración de la diálisis. El virus B puede producir glomerulonefritis y lesión renal relacionada con poliarteritis nodosa. La prevención de la infección en estos pacientes incluye medidas de protección durante la diálisis, esquemas de vacunación diferenciados, control riguroso de los productos sanguíneos utilizados y monitoreo serológico de pacientes y personal.
The risk to acquire hepatitis B in patients with chronic renal insufficiency depends on the type and duration of the dialysis. The HBV can cause glomerulonephritis and renal injury related with polyarteritis nodosa. Prevention of the infection in these patients includes: protective measures during dialysis, differentiated schemes of vaccination, rigorous control of blood products used and serologic monitoring of patients and personnel.
Subject(s)
Humans , Hepatitis B virus/drug effects , Renal Dialysis , Renal Insufficiency, ChronicABSTRACT
Introdução: A palavra pica é definida como o desejo intenso e persistente da ingestão de itens não-alimentares com pouco ou nenhum valor nutricional.Pacientes em diálise podem estar propensos a tal distúrbio. Objetivo: Investigar a prevalência de pica em pacientes em diálise peritoneal. Métodos:Através de entrevista e aplicação de questionário, foram avaliados 106 pacientes maiores de 20 anos, submetidos à diálise peritoneal ambulatorial contínua(DPAC) ou à diálise peritoneal automatizada (DPA). Nos pacientes que apresentavam pica, foram coletados exames bioquímicos, incluindo: albumina,cálcio, creatinina, ferritina, ferro, fósforo, glicemia, hematócrito, hemoglobina, potássio, transferrina e uréia séricos, além do Kt/V para determinação da adequação dialítica. Os pacientes tiveram peso e estatura medidos, para cálculo do índice de massa corporal (IMC). Resultados: A idade dos pacientes foi de 57,1±14,3 anos (média±DP). Observou-se que 32% (n=34) dos indivíduos entrevistados apresentavam pica. Destes, a maioria dos praticantes(76,5%, n=26) era do sexo feminino. Os itens ingeridos em maior prevalência foram: gelo (25%), vinagre (20,8%) e suco de limão puros (12,5%). Não houvediferença significativa na presença de pica entre obesos e não obesos, assim como o problema não foi associado à anemia, sobrepeso ou à inadequacidade dialítica. Conclusão: A ingestão de itens não-alimentares não é um achado incomum na população em diálise peritoneal.
Introduction: The word pica is defined as an intensive and persistent desire for the intake of non-food items with little or no nutritional value. Dialysis patientsmay be susceptible to such disturbance. Objective: To investigate the prevalence of pica in a population of peritoneal dialysis patients. Methods: An openinterview and a questionnaire were applied to 106 patients in continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD).Patients younger than 20 years were excluded from the study. For those patients who presented pica, biochemical analysis was performed, which included the serum measurements of albumin, calcium, creatinine, ferritin, iron, phosphorus, glucose, hematocrit, hemoglobin, potassium, transferrin and urea. Moreover, the delivery dose of dialysis was assessed by the calculation of Kt/V. Also, the body mass index (BMI) was calculated using measured weight and height. Results: The pica practice was observed in 32% (n=34) of the PD patients, whose age was 57.1±14.3 years (mean ±SD). From these patients, the majority of pica practitioners (76.5%, n=26) was female. The most reported consumed items were: ice (25%), pure vinegar (20.8%) and lemon juice(12.5%). There was no significant difference in the presence of pica between obese and non-obese patients, and the problem was not associated w i t h anemia, overweight or dialysis inadequacy. Conclusion: The intake of non-food items is not an uncommon finding in the peritoneal dialysis population.