ABSTRACT
Introducción: algunos autores sostienen que los pacientes >65 años dificultan a la DP como una opción dialítica. Objetivos: Analizar la efectividad dialítica en >65 años tratados en DP. Material y métodos: Se estudiaron desde 1/2011 a 1/2015, 27 pacientes >65 años. 19 varones y 8 mujeres, edad 74,6 años (65-87), tiempo en DP 42,9 (5-55) meses. 14 DPCA y 13 DPA. Se analizaron indicadores clínicos, tasa de peritonitis, ôdrop-outõ total por peritonitis y por muerte, requerimiento de cuidador y calidad de vida. Resultados: Requirieron de cuidador 9(33%). Tuvieron peritonitis 13 (48%), 7 solo un episodio que no causó morbilidad y 6 salieron de DP por peritonitis. Episodios de peritonitis 1/50 mp. Salieron 11 pacientes (40,7%), 4 por peritonitis. Murieron 2 pacientes de peritonitis, 4 fueron transferidos a HD y 1 recuperó la función renal. Los indicadores clínicos: Kt/v> 1,7, 85% y 78%; P plasmático 8,5 mg/dl 87%, Hb> 10 g/dl 81%PTH entre 150 y 400 pg/ml 67% y albúmina plasmática >3,5 g/dl 78% para ambas terapias. Sobrevida de la técnica: 62%, 55%, 40%, y 25%, a 12, 24, 36 y 48 meses respectivamente. Se observó mayor tiempo de entrenamiento, menor destreza, más infecciones respiratorias y complicaciones cardiovasculares. Conclusiones: Los "pacientes de la tercera edad" obligan a un tratamiento multidisciplinario. La DP es una terapia con ventajas en pacientes con enfermedad cardiovascular y dificultades para lograr un acceso vascular. Las complicaciones asociadas a la DP no son diferentes respecto a los pacientes más jóvenes.
Introduction: some authors say that patients over 65 years of age reject PD as a dialytic option. Objetives: To analyze dialytic effectiveness in patients >=65 years old on PD. Material and Methods: From 1/2011 to 1/2015, 27 patients over 65 years were studied. 19 males and 8 females, age 74.6 years (65-87), period of time on PD : 42.9 (5-55) months. 14 CAPD and 13 APD. Clinical indicators, peritonitis rate, total dropout because of peritonitis and death, nursing requirements and quality of life. Results: 9 (33%) required nursing. 13 had peritonitis (48%), 7 had only one episode that did not cause morbility and 6 dropped out from PD due to peritonitis. Peritonitis episodes 1/50 mp. 11 patients dropped out (40.7%), 4 because of peritonitis. 2 patients died due to peritonitis, 4 were transferred to HD and 1 recovered renal function. Clinical indicators: Kt/v>=1.7, 85% and 78%; Serum P p= 8.5 mg/dl 87%, HB= 3.5 g/dl 78% for both therapies. Technique survival: 62%, 55%, 40%, and 25% in 12, 24, 36 and 48 months respectively. Longer training time, lesser skill, more respiratory infections and cardiovascular complications were observed. Conclusions: ?Third age patients? demand a multidisciplinary treatment. PD is an advantageous therapy in patients suffering from cardiovascular diseases and difficulties to achieve a vascular access. Complications associated to PD do not differ from those applied to younger patients.
Subject(s)
Male , Female , Humans , Aged , Effectiveness , Peritoneal Dialysis , Renal Dialysis , Peritonitis , Quality of LifeSubject(s)
Male , Female , Humans , Calcinosis , Calcium Metabolism Disorders , Peritoneal Dialysis , Renal DialysisABSTRACT
INTRODUCTION: Treatment of patients with resistant/relapsed adult nephrotic syndrome (RNS) caused by glomerulopathies has no consensus therapy. OBJECTIVES: This is a retrospective analysis (RA), performed on 55 patients with RNS treated during one year with enteric coated sodium mycophenolate (EC-MPS) and reduced corticosteroids doses. MATERIAL AND METHODS: Inclusion criteria for this RA were: patients aged ≥ 18 years old, diagnosed with RNS with histologically proven glomerulopathy who had received standard therapy with enalapril and/or losartan and 10 mg per day or 20 mg of prednisone every other day. NS was defined with the following criteria: proteinuria > 3.5 g/day, serum albumin ≤ 3 g/dl, hypercholesterolemia and edema. Treatment consisted of oral EC-MPS in 360 mg tablets, 720 mg bid, together with prednisone 10 mg daily or 20 mg every other day. Effectiveness was assessed as the rate of response in the cohort: complete, partial or absent. Complete response patients: 24 hours proteinuria < 300 mg/day, partial response patients: proteinuria > 300 mg/day and < than 3 g/day, all the rest were considered as non responders. RESULTS: response was achieved in 40/55 (73%) of patients, 24 (44%) with complete response and 16 (29%) with partial response. No EC-MPS discontinuation has been observed due to adverse events, except for one case of transient interruption of medication for 2 weeks. CONCLUSION: EC-MPS as single therapy with minimal doses of corticosteroids as in this RA could be an effective alternative in the treatment of patients with RNS.
