Prevalencia de pseudohipercaliemia en pacientes con enfermedad renal crónica en terapia hemodialítica / Prevalence of pseudohyperkalemia in patients with chronic renal disease in hemodialysis therapy

Objetivo: determinar si a la hipercaliemia prolongada en pacientes en hemodiálisis con enfermedad renal crónica (ERC) contribuye en valor significativo la presencia de pseudohipercaliemia (diferencia entre potasio sérico a plasmático mayor a 0.5 mEq/L) Pacientes: aquellos con ERC en terapia hemodialítica por más de 12 meses de evolución en quienes se detectara hipercaliemia persistente por más de tres meses. Material y métodos: determinación simultánea de potasio sérico y plasmático, y adicionalmente las variables sodio sérico, gases arteriales, cuadro hemático completo, glucemia en ayunas, Kt/v y electrocardiograma Resultados: en 110 pacientes evaluados 17 cumplieron los criterios de inclusión, en ellos en 13 (76.47%) se detectó pseudohipercaliemia y en 4 (23.52%) hipercaliemia verdadera (diferencia entre potasio sérico a plasmático menor a 0.5 mEq/L). No se detectaron diferencias significativas entre grupos en las variables analizadas Conclusión: la pseudohipercaliemia representa un porcentaje muy importante del reporte de hipercaliemias en pacientes con ERC en terapia hemodialítica, y lo ideal en ellos es siempre determinar potasio plasmático. (Acta Med Colomb 2013; 38: 12-15).

Objective: determine if to prolonged hyperkalemia in hemodialysis patients with chronic kidney disease (CKD) contributes significantly the presence of pseudohyperkalemia (difference between serum to plasma potassium greater than 0.5 mEq/L) Patients: those with CKD on hemodialysis therapy for more than 12 months duration in whom persistent hyperkalemia is detected for more than three months. Materials and methods: simultaneous determination of serum and plasma potassium and in addition the variables serum sodium, arterial blood gases, complete blood count, fasting blood glucose, Kt / v and electrocardiogram Results: in 110 patients evaluated 17 met the inclusion criteria. In 13 of them (76.47%) we detected pseudohyperkalemia and in 4 (23.52%) true hyperkalemia (difference between serum to plasma potasium less than 0.5 mEq / L ). No significant differences between groups in the variables analyzed were detected. Conclusion: the pseudohyperkalemia represents a very important percentage of the report of hiperkalemias in CKD patients on hemodialysis therapy, and ideally plasma potasium has to be determined always in these patients. (Acta Med Colomb 2013; 38: 12-15).

Fungal peritonitis in peritoneal dialysis patients: successful prophylaxis with fluconazole, as demonstrated by prospective randomized control trial.

OBJECTIVES: To determine whether oral administration of the antifungal fluconazole during the entire period of treatment of bacterial peritonitis (BP), exit-site infection (ESI), or tunnel infection (TI) prevents later appearance of fungal peritonitis (called secondary) in patients with chronic kidney disease stage 5 in a peritoneal dialysis (PD) program. ♢ PATIENTS AND METHODS: All patients treated in the PD program in RTS Ltda Sucursal Caldas, during the period 1 June 2004 to 30 October 2007 were screened. Patients that had infectious bacterial complications (BP, ESI, TI) were included in a prospective randomized trial to receive or not receive oral fluconazole (200 mg every 48 hours) throughout the time period required by the administration of therapeutic antibiotics via any route. It was evaluated whether the fungal peritonitis complication appeared within 30 - 150 days following the end of antibacterial treatment. Based on local results, the sample size necessary to obtain statistically significant results was determined to be 434 episodes of peritonitis. ♢ RESULTS: The 434 episodes of peritonitis presented between the previously specified dates and during this same period there were 174 ESI or TI, of which only 52 received oral antibiotic treatment. Information in relation to consumption of antibiotics for purposes other than BP, ESI, and TI was not reliable and thus this variable was excluded. Among the episodes of peritonitis, 402 (92.6%) were of bacterial origin and 32 (7.3%) were mycotic, mainly Candida species [30 (93.75%)]. Of the fungal peritonitis, 14 (43.73%) were primary (without prior use of antibiotics) and 18 (56.25%) were secondary. In the group of patients that received prophylaxis with fluconazole (210 for BP and 26 for ESI or TI), only 3 occurrences of fungal peritonitis were observed within 30 - 150 days of its administration, which is opposite to the group without prophylaxis (210 for BP and 26 for ESI or TI), in which 15 occurrences of fungal peritonitis were detected. Statistical analysis of the group of patients with BP found comparisons of the proportions of those receiving fluconazole (0.92%) or not (6.45%) presented a highly significant difference in favor of prophylaxis (p = 0.0051, Z = 2.8021). Given that only 1 patient in each group with ESI or TI, with or without prophylaxis, presented the complication fungal peritonitis, it was concluded that this result was not statistically significant. During laparoscopic surgery attempting reintroduction of the peritoneal catheter, it was found that 11 patients had severe adhesions or peritoneal fibrosis leading to obliteration of the peritoneal cavity. In 19 patients, reintroduction of the catheter was possible and the patients returned to PD without consequence. ♢ CONCLUSION: In patients with bacterial peritonitis, administration of prophylactic oral fluconazole throughout the time they received antibiotics significantly prevented the appearance of secondary fungal peritonitis.

Controversia en relación con el uso de bifosfonatos en pacientes con enfermedad renal / Controversy about the use of bisphosphonates in patients with kidney disease

Los bifosfonatos son medicamentos antirreabsortivos gracias a su capacidad de alterar las funciones de los osteoclastos, en los que llegan también a inducir apoptosis. Otros beneficios terapéuticos de estos medicamentos son su acción antiinflamatoria e inhibidora de la formación de placas arterioscleróticas. Clásicamente la presencia de alteraciones en la función renal ha sido una contraindicación para su uso, pero evidencia reciente ha demostrado que con adecuado ajuste de su dosis, o seleccionando bifosfonatos con bajo perfil de toxicidad, alto grado de fijación ósea y a proteínas séricas, y alta remoción en la terapia dialítica podrían ser un arma terapéutica excelente en patologías que simultáneamente afecten los riñones y otros órganos como el mieloma múltiple, y en estados hiperfosfatémicos asociados a alto recambio óseo.