Hypokalemia and hyperkalemia in patients on peritoneal dialysis: incidence and associated factors.

BACKGROUND: Hypokalemia is a well-described electrolyte disturbance in patients on peritoneal dialysis (PD). Hyperkalemia, however, is still overlooked, although it also represents a risk factor for mortality. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (ACE/ARB), diuretics, and proton pump inhibitor (PPI) can interfere with potassium levels in these patients. METHODS: This is a retrospective study that evaluated monthly serum potassium in a 5-year period. Serum potassium disturbances were evaluated as time-average and number of hypo- and hyperkalemia episodes per patient. Prescribed medication such as ACE/ARB, diuretics, and omeprazole were recorded. RESULTS: We evaluated 2025 potassium measurements obtained from 146 patients on PD. Serum potassium ranged from 2.5 to 8.3 mEq/L with an average of 4.72 ± 0.74 mEq/L. Hypokalemia was found in 59 measurements (2.9%) obtained from 35 patients (23.9%) whereas hyperkalemia was demonstrated in 269 (13.3%) measurements obtained from 74 patients (50.7%). Hypokalemia was associated with low albumin (p = 0.022), and omeprazole use (p = 0.024). Black race was a protector factor (p = 0.031). Omeprazole-associated hypokalemia was seen only in non-anuric patients and remained an independent risk factor even after adjustments. Patients who had hyperkalemia were more likely to be anuric (p = 0.001) and in use of furosemide (p = 0.0001). CONCLUSION: Hyperkalemia and hypokalemia are very frequent in patients on PD and should be closely monitored. Interventional studies should address the impact of discontinuing omeprazole in the levels of potassium.

Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism.

BACKGROUND: Secondary hyperparathyroidism (SHPT) and its associated abnormalities in mineral metabolism increase the risk of cardiovascular morbidity and death in chronic renal failure (CRF). The effect of parathyroidectomy (PTX) on the incidence of major cardiovascular events in CRF patients with SHPT is unknown. We tested the hypothesis that PTX reduces the incidence of cardiovascular complications and death in CRF patients with severe SHPT scheduled for PTX, comparing the outcome of patients treated or not treated by PTX. METHODS: The study comprised 118 CRF patients with SHPT on maintenance hemodialysis, unresponsive to medical treatment and scheduled for PTX. Patients underwent comprehensive cardiovascular evaluations at baseline. They were followed up until death, occurrence of major cardiovascular events, or kidney transplantation. RESULTS: No deaths related to PTX occurred. After a median follow-up of 30 months, 50 patients (42%) had undergone PTX whereas 68 (58%) had not. The groups were comparable in terms of age, sex, race, serum parathyroid hormone, calcium or phosphate, calcium x phosphate product, and all major cardiovascular variables, except diastolic blood pressure. PTX was associated with a reduced incidence of major cardiovascular events (P = .02) and overall mortality (P

Nível sanguíneo de ciclosporina: método policlonal e rejeiçäo aguda pós-transplante renal / Blood level of cyclosporine: polyclonal method and acute rejection after kidney transplantation

Os níveis sanguíneos de ciclosporina (CsA) determinados pelo Kit Policlonal Sandoz e sua correlaçäo com presença ou näo de rejeiçäo aguda nos primeiros 30 dias pós-transplante foram analisados em 34 paciente. Consideramos, nos casos de rejeiçäo, aqueles níveis avaliados nos sete dias que antecederam a crise. Todos os pacientes estavam recebendo esquema tríplice de imunossupressäo e o doador era relacionado em 17 casos, cadáver em 10 e vivo näo relacionado em sete. Vinte e seis pacientes eram adultos e oito, crianças. Nas ocasiöes em que houve rejeiçäo aguda, o nível de ciclosporina foi inferior a 300ng/ml em 20 casos (80%) e nas 45 vezes sem rejeiçäo o nível foi superior a 300 ng/ml em 19 casos (42,1%); X* = 3,523; p = 0,0572. Quando consideramos o nivel inferior a 400 ng/ml, houve diferença (X* = 1,921). A dose de CsA em mg por Kg de peso näo foi diferente nos pacientes com e sem rejeiçäo, 6,3 ñ 1,4 no 1§ grupo e 6,8 ñ 1,9 no 2§ grupo. O nível sanguíneo de CsA no grupo com rejeiçäo foi de 223 ñ 220ng/ml e no grupo sem rejeiçäo, 355 ñ 325ng/ml (p = 0,071). Concluímos que o nível sanguíneo de CsA medido pelo Kit Policonal acima de 300ng/ml é aquele que mais protege o rim da rejeiçäo e este näo precisa ser superior a 300ng/ml. Näo houve diferença entre a dose por Kg de peso nos dois grupos, com e sem rejeiçäo, justificando a necessidade de dosagem do nível sanguíneo de CsA