RESUMO
There is increasing evidence that small variations within the normal range (3.5-5mEq/L) of potassium are associated with mortality. OBJECTIVE: To determine whether there is an association between serum potassium level (sK) and mortality in a cohort of elderly hypertensive patients. PATIENTS AND METHODS: A retrospective, observational study was conducted on patients who had sK levels available in a period of clinical stability during their recruitment between January and April 2006 and followed-up for 10 years. The study obtained a total of 62 stable patients, with a mean age of 82.19±6 years (range 69-97), with 74.2% women, 33.9% diabetics, 20.3% with a history of heart failure, Ischaemic heart disease was observed in 19.4% and 44.3% received Angiotensin Converting Enzyme (ACE) inhibitors. An analysis was performed on the mortality rate during the 10 year period. The statistics were performed using the SPSS15.0 package. RESULTS: There were 49 deaths. The sK had a normal distribution. Baseline mean sK levels and median were 4.45±0.5mEq/L (range 3.1-5.5 mEq/L). Baseline sK levels were significantly higher in diabetic patients and patients on ACE inhibitors. The patients that died had higher sK levels (4.53±0.49mEq/L versus 4.14±0.40mEq/L, P=.011). Survival estimated using Kaplan Meier showed that patients with sK levels higher than the median and P75 had higher mortality. CONCLUSIONS: In our study, sK levels greater than 4.45mEq/L were associated with mortality. When selecting antihypertensive treatment in hypertensive elderly patients,, the use of ACE inhibitors should be assessed individually, with close monitoring at sK levels and try to keep them in the lower limit of the normal range (<4.45 mEq/L).
RESUMO
Serum aldosteronelevels (SA) are a marker of cardiovascular (CV) risk in the general population. OBJECTIVE: To analyze SA levels in dialysis patients and its relationship with characteristics of dialysis; comorbidity; blood pressure and the use of blocking renin-angiotensin-aldosterone system agents (BSRAA). METHODS: We determined SA in 102 patients: 81 on hemodialysis (HD) and 21 on peritoneal dialysis. Mean age 71.4±12 years; 54.9% male; 29.4% diabetics. Mean time on dialysis 59.3±67 months. In 44 HD patients plasma renin activity (PRA) was measured. RESULTS: Mean SA was 72.6±114.9ng/dl (normal range 1.17-23.6ng/dl). A total of 57.8% of patients had above normal levels which were not related to dialysis characteristics or comorbidity. Only 21% of patients with heart failure and 19.2% with ischemic heart disease used BSRAA. A number of 25 patients treated with BSRAA had significantly lower levels of SA. There was an inverse correlation between AS and systolic blood pressure (SBP), and direct with PRA. The logistic regression analysis conducted to find SA levels above the median associated factors showed that SBP was the only independent risk variable in the overall population (OR 0.97; P=.022); in the 44 patients in whom PRA was determined this was the only independent risk factor (OR 2.24; P=.012). CONCLUSIONS: A high percentage of dialysis patients have elevated levels of SA that are associated to diminished SBP and activated PRA and not to dialysis characteristics. In patients with a history of heart disease we underuse BSRAA.
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Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Assistência a Idosos/tendências , Saúde do Idoso , Idoso Fragilizado , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Estudos Retrospectivos , Comorbidade , Falência Renal Crônica/mortalidade , Taxa de Filtração GlomerularAssuntos
Ciclofosfamida/administração & dosagem , Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Nefrite Lúpica/tratamento farmacológico , Síndrome Nefrótica/etiologia , Doença Aguda , Ciclofosfamida/uso terapêutico , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Edema/etiologia , Emergências , Hematúria/etiologia , Humanos , Imunossupressores/uso terapêutico , Nefrite Lúpica/complicações , Nefrite Lúpica/patologia , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Síndrome Nefrótica/patologia , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Adulto JovemAssuntos
Injúria Renal Aguda/etiologia , Glomerulonefrite por IGA/diagnóstico , Injúria Renal Aguda/tratamento farmacológico , Injúria Renal Aguda/terapia , Adenocarcinoma/complicações , Adenocarcinoma/radioterapia , Idoso , Compostos de Bifenilo/administração & dosagem , Compostos de Bifenilo/uso terapêutico , Progressão da Doença , Diuréticos/administração & dosagem , Diuréticos/uso terapêutico , Doxazossina/administração & dosagem , Doxazossina/uso terapêutico , Quimioterapia Combinada , Enalapril/administração & dosagem , Enalapril/uso terapêutico , Furosemida/administração & dosagem , Furosemida/uso terapêutico , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/tratamento farmacológico , Humanos , Irbesartana , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Noctúria/etiologia , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Neoplasias da Próstata/complicações , Neoplasias da Próstata/radioterapia , Indução de Remissão , Diálise Renal , Tetrazóis/administração & dosagem , Tetrazóis/uso terapêuticoRESUMO
Background: We aimed to evaluate the relationship between serum leptin and the leptin/body mass index (BMI) ratio with prevalent cardiovascular disease (CVD), and their influence on allcause and CVDrelated mortality in patients on hemodialysis (HD). Methods: 118 stable HD patients (50 women, median [interquartile range] age, 65.1 [54.772.2] years) were studied. All patients had baseline measurement of serum leptin concentrations. Relationships between leptin and allcause and CVD mortality were studied by means of survival analysis and Cox regression analysis. Results: The leptin/BMI ratio was similar in patients with and without CVD at baseline (0.65 [0.292.23] vs. 0.68 [0.291.49] ng·m2/ml·kg, respectively, NS). Multiple logistic regression analysis showed that there was not an independent association between leptin/BMI ratio and prevalent CVD. During the followup time, 52 (44.1%) patients died. CVD was the cause of death in 27 out of 52 (51.9%) deceased patients. Survival analysis and Cox proportional multivariate regression analysis showed that there were no significant relationships between leptin levels or the leptin/BMI ratio and allcause and CVDrelated mortality. Conclusion: These results do not support that, in stable HD patients, serum leptin concentrations and the leptin/BMI ratio are related with prevalent CVD. Leptin/BMI ratio seems not to be a risk factor for mortality in these patients (AU)
Introducción: El objetivo del presente estudio ha sido evaluar la relación entre la leptina sérica y el cociente leptina/índice de masa corporal (IMC) con la enfermedad cardiovascular (ECV) prevalente y su influencia en la mortalidad global y en la mortalidad por ECV en pacientes en hemodiálisis (HD). Métodos: Se estudiaron 118 pacientes estables en HD (50 mujeres, edad mediana [recorrido intercuartílico], 65,1 [54,772,2] años). En todos los pacientes se cuantificó la concentración basal de leptina. La relación entre leptina y la mortalidad se evaluó mediante análisis de supervivencia y análisis de regresión de Cox. Resultados: El cociente leptina/IMC fue similar en pacientes con y sin ECV prevalente (0,65 [0,292,23] frente a 0,68 [0,291,49] ng·m2/ml·kg, respectivamente, NS). El análisis de regresión logística mostró que no existía una asociación independiente entre el cociente leptina/IMC y la enfermedad cardiovascular prevalente. Durante el seguimiento 52 pacientes fallecieron (44,1%). La ECV fue causa de muerte en 27 de 52 pacientes fallecidos (51,9%). El análisis de supervivencia y el análisis multivariante de Cox mostraron que no hubo relación significativa entre los niveles de leptina o el cociente leptina/IMC y la mortalidad global o por causa de ECV. Conclusión: Estos resultados no apoyan la hipótesis de que, en pacientes estables en HD, las concentraciones de leptina y el cociente leptina/IMC estén relacionados con la ECV prevalente. Más aún, el cociente leptina/IMC no parece ser un factor de riesgo de mortalidad en estos pacientes (AU)
Assuntos
Humanos , Insuficiência Renal Crônica/complicações , Doenças Cardiovasculares/mortalidade , Diálise Renal/estatística & dados numéricos , Leptina/sangue , Fatores de Risco , Índice de Massa CorporalRESUMO
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Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Diabetes Mellitus/epidemiologia , Nefropatias Diabéticas/complicações , Falência Renal Crônica/epidemiologia , Complicações do Diabetes/epidemiologiaAssuntos
Nefropatias Diabéticas/etiologia , Falência Renal Crônica/prevenção & controle , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Terapia Combinada , Diagnóstico Tardio , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Cardiomiopatias Diabéticas/diagnóstico por imagem , Cardiomiopatias Diabéticas/etiologia , Cardiomiopatias Diabéticas/patologia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/diagnóstico por imagem , Nefropatias Diabéticas/tratamento farmacológico , Nefropatias Diabéticas/patologia , Nefropatias Diabéticas/terapia , Progressão da Doença , Resistência a Medicamentos , Quimioterapia Combinada , Humanos , Hidronefrose/etiologia , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/etiologia , Masculino , Pessoa de Meia-Idade , Proteinúria/etiologia , Radiografia , Diálise Renal , Sistema Renina-Angiotensina/efeitos dos fármacos , Sistema Renina-Angiotensina/fisiologia , UltrassonografiaRESUMO
INTRODUCTION: The use of solutions containing hypertonic glucose (3.86%/4.25%) has been postulated as the method of choice for study the peritoneal function, and permits a better evaluation of the ultrafiltration (UF) capacity. OBJECTIVE: The aim of our study was to analyze the UF capacity and its relation with the peritoneal permeability and sieving of sodium, performing the peritoneal kinetic study with hypertonic glucose solutions. PATIENTS AND METHODS: We performed 184 peritoneal kinetic studies with hypertonic glucose solutions in stable patients on peritoneal dialysis (PD), with a mean time on PD of 16 +/- 22 months. We measured the mass transfer coefficient of creatinine (CrMTC), dialysate to plasma ratio of creatinine (D/PCr), UF capacity and sieving of sodium at 60 minutes (difNa60). RESULTS: The mean values were: CrMTC: 9.1 +/- 4.5 ml/min, D/PCr: 0.71 +/- 0.09, UF 759 +/- 233 ml/4 h and difNa60: 4.7 +/- 2.3. The best multivariate model that predicts the UF capacity included: difNa60, CrMTC, age and time on PD (r = 0.57; p > 0.0001). In patients with UF lower than 600 ml/4 h (Percentil 25) the correlation between UF and CrMTC was lost, but remains the correlation with difNa60 (r = 0.48). The patients with previous peritonitis (n = 38) showed no differences in UF, CrMTC or D/Pcr, but the had lower difNa60 (3.7 +/- 2.8 vs. 4.9 +/- 2.1; p = 0.002) than the remaining patients. CONCLUSIONS: The peritoneal kinetic study performed with hypertonic glucose allows to standardize the UF capacity and by determination of sieving of sodium, the early detection of water transport alterations, before the UF capacity and small solutes permeability alteration develops.
Assuntos
Líquido Ascítico/metabolismo , Solução Hipertônica de Glucose/farmacocinética , Diálise Peritoneal , Sódio/farmacocinética , Ultrafiltração , Água Corporal/metabolismo , Creatinina/metabolismo , Nefropatias Diabéticas/metabolismo , Nefropatias Diabéticas/terapia , Feminino , Humanos , Falência Renal Crônica/metabolismo , Falência Renal Crônica/terapia , Masculino , Peritonite/metabolismo , Permeabilidade , Ureia/metabolismoRESUMO
La enfermedad renal crónica se considera un problema de salud pública desde la aplicación de las Guías KDOQI/NKF. La mayoría de los pacientes diagnosticados de enfermedad renal crónica son ancianos. En estos pacientes la progresión de la enfermedad renal es lenta, y la mortalidad superior al desarrollo de una insuficiencia renal que requiera el empleo de diálisis. Las guías actuales deben aplicarse con cautela en estos ancianos (AU)
Chronic kidney disease is considered to be a problem of public health problem from the application of Guidelines KDOQI/NKF. Majority patients diagnosed of chronic kidney disease are elderly. In these patients progression of renal disease is slow, being the mortality high to development of renal failure that needs dialysis. The current guidelines must apply with caution in these elders (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Insuficiência Renal Crônica/fisiopatologia , Testes de Função Renal , Terapia de Substituição Renal , Progressão da Doença , Taxa de Filtração Glomerular , Creatinina/sangue , Fatores de RiscoRESUMO
INTRODUCTION: Low serum free triiodothyronine (FT3) concentrations have been reported in a high percentage of chronic renal failure patients and have been considered as an independent predictor of mortality in dialysis patients. OBJECTIVE: Our aim has been to evaluate the prognostic value of FT3 levels for long-term mortality in stable hemodialysis patients surviving at least 12 months. PATIENTS AND MEASUREMENTS: We retrospectively analyzed 89 stable hemodialysis patients (50 males; mean age 67.9 +/- 11.8 years). All patients had a baseline clinical and analytical evaluation. We analyzed the relationship between baseline FT3 and mortality by means of survival analysis (Kaplan-Meier) and Cox regression analysis. RESULTS: Mean values of thyroid function test were: thyrotropin (TSH) 2.02 +/- 1.5 microU/ml, free thyroxine (FT4) 1.26 +/- 0.23 ng/dl, and FT3 2.7 +/- 0.4 pg/ml. During a median follow-up time of 33.6 +/- 14.9 (12 - 62) months, 41 patients died. FT3 was similar in patients who died or survived (2.6 +/- 0.5 vs. 2.7 +/- 0.4 pg/ml ns). Kaplan-Meier analysis did not show significant differences in mean survival according to tertiles of FT3. In multivariate Cox regression analysis, FT3 was not a predictor of mortality (RR 0,001; 95% CI; 0.000 to 1.73). CONCLUSIONS: These data suggest that low FT3 levels are not predictive for mortality in a subgroup of stable HD patients who could survive more than 12 months.
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Falência Renal Crônica/sangue , Diálise Renal/mortalidade , Tri-Iodotironina/sangue , Idoso , Biomarcadores/sangue , Feminino , Seguimentos , Humanos , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Taxa de Sobrevida/tendências , Fatores de Tempo , Tri-Iodotironina/deficiênciaRESUMO
Chronic kidney disease is considered to be a problem of public health problem from the application of Guidelines KDOQI/NKF. Majority patients diagnosed of chronic kidney disease are elderly. In these patients progression of renal disease is slow, being the mortality high to development of renal failure that needs dialysis. The current guidelines must apply with caution in these elders.