RESUMO
Intraperitoneal pressure (IPP) is gaining consideration as a relevant parameter of peritoneal dialysis (PD) in adults, although many of its aspects are still pending clarification. We address here its stability over time and the validity of the usual method of clinical measurement, as proposed by Durand in 1992 but never specifically validated. We performed this validation by comparing Durand's method and direct measurements with a central venous pressure system. We performed a total of 250 measurement pairs in 50 patients with different intraperitoneal volumes plus in-vitro measurements with a simulated peritoneum. Absolute differences between the two systems in vivo were 0.87 ± 0.91 cmH2O (range 0-5 cmH2O); only 6.4% of them were ≥3 cmH2O. In vitro results for both methods were identical. We also compared IPP measurements in the same patient separated by 1-4 h (514 measurement pairs in 136 patients), 1 week (92 pairs in 92 patients), and 2 years (34 pairs in 17 patients). Net differences of measurements separated by hours or 1 week were close to 0 cmH2O, with oscillations of 1.5 cmH2O in hours and 2.3 cmH2O in 1 week. IPP measured 2 years apart presented a net decrease of 2.5 ± 4.9 cmH2O, without correlation with body mass index changes or any other usual parameter of PD. In hours, 7% of IPP differences were >3 cmH2O, 22% in 1 week, and 50% in 2 years. In conclusion, Durand's method is precise enough to measure IPP in peritoneal dialysis. This parameter is not stable over long timescales, so it is necessary to use recent measurements.
Assuntos
Diálise Peritoneal , Adulto , Índice de Massa Corporal , Humanos , Cavidade Peritoneal , Peritônio , PressãoRESUMO
La malnutrición es uno de los mayores predictores de mortalidad de pacientes en diálisis. La inflamación, el hipercatabolismo asociado al procedimiento dialítico, las situaciones comórbidas y la reducción en la ingesta calórica y proteica son causas de mal nutrición en estos pacientes. La disponibilidad de un marcador nutricional ideal(sensible, fácil de medir y reproducible) es difícil debido a los cambios metabólicos asociados a la insuficiencia renal. Para conocer el estado nutricional de los pacientes y hacer recomendaciones individualizadas, es necesario utilizar un conjunto de medidas antropométricas, bioquímicas y dietéticas; por otro lado el análisis del vector obtenido mediante bio-impedancia ha sido validado para su empleo en estos pacientes y podría ayudar en la detección temprana de alteraciones nutricionales. En este estudio evaluamos la prevalencia de mal nutrición en 43 pacientes en programa de diálisis usando parámetros antropométricos y bioquímicos clásicos, así como encuestas dietéticas y análisis de bioimpedancia vectorial. Según parámetros bioquímicos entre un 41,9% al 53% de nuestros pacientes presentaban malnutrición; al utilizar parámetros antropométricos solamente el 26 % estaba malnutrido. El análisis por bioimpedancia demostró que el18,6% de ellos mostraban una reducción en su masa corporal total. Los parámetros antropométricos y de bioimpedancia se encontraban dentro del rango normal en la mayoría de los pacientes. Los pacientes con una adecuada ingesta proteico-calórica no mostraron mejores parámetros nutricionales que el resto en términos bioquímicos y de composición corporal. Por ello creemos que más que un problema de ingesta, la malnutrición en estos pacientes es resultado de inflamación e hipercatabolismo (AU)
Malnutrition is one the most powerful independent predictors of morbimortality in patients on chronic dialysis. Inflammation, hyper catabolism associated to the dialysis procedure, comorbidities and reductions in protein and calories ingestion are though to be the main causes of malnutrition in those patients. The availability of an ideal (sensible, easy to measure, and reproducible) malnutrition marker, is difficulties by the metabolic changes associated to chronic renal failure. To know the nutritional status of a patient, in order to make individual nutritional recommendations, it is necessary to use a panel of anthropometric, biochemical and dietary measurements; on the other hand, bioelectrical impedance vector analysis has been validated for its use in patients on hemo and peritoneal dialysis and might be helpful for the early detection of nutritional alterations. In this study we evaluated the prevalence of mal nutrition in 43 stable dialysis patients, using classical biochemical and anthropometrics parameters, as well as dietary surveys, and bioelectrical impedance vector analysis. According to biochemical parameters, 41,9% to 53% of our patients showed malnutrition, whereas using anthropometrics parameters only 26% were malnourished. Bioelectrical impedance vector analysis demonstrated that18,6 % of patients showed a reduction on total body fat. Anthropometric and bioimpedance muscle parameters were within normal range in most patients. Patients with an adequate protein-calorie ingestion did not showed better nutritional parameters than the rest, in terms of biochemical and body composition values, so we think that more than a problem of ingestion, malnutrition in these patients is the result of inflammation and hyper catabolism (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Diálise/métodos , Unidades Hospitalares de Hemodiálise/organização & administração , Unidades Hospitalares de Hemodiálise/normas , Antropometria/métodos , Impedância Elétrica , Desnutrição/dietoterapia , Desnutrição/prevenção & controle , Índice de Massa Corporal , Estudos Transversais , Inquéritos NutricionaisRESUMO
El pasado día 13 de Diciembre se cumplieron treinta y cinco años de la Reunión Científica celebrada en 1975, en la sede del Colegio de Médicos de Barcelona, que sería el acto fundacional de la Sociedad Española de Inmunología y su Primer Congreso. En este escrito, al hilo de los recuerdos personales de diversas personas que asistieron a aquel acto, y también de la comparación de los contenidos de ese Primer Congreso con los del 35 Congresocelebrado en Palma de Mallorca en 2008, se realizan diversas consideraciones sobre el desarrollo de la Inmunología en España en estos treinta y cinco años (AU)
LLast December 13th was the 35th anniversary of the celebration in1975, in the facilities of the Medical College of Barcelona, of a ScientificMeeting which would become the foundational act of the Spanish Societyof Immunology and its First Congress. Here, we present a few reflectionson the development of Immunology in Spain during this time, throughthe personal memories of some of the people attending that meeting, andcomparing the contents of the 1st Congress with those of the 35th Congress held in Palma de Mallorca in 2008 (AU)
