Determinant Variables of Resistive Index in Early Renal Transplant Recipients.

BACKGROUND: The resistive index (RI) is used to evaluate renal allograft perfusion and dysfunction. Whereas the RI prognostic role for graft function has received considerable attention, less attention was paid to potential determinants of RI. The aim of this study was to present the results of interlobar artery RI, with special attention given to variables associated with it within 1 week posttransplantation. METHODS: In 125 patients, the association of several variables with the RI grouped in tertiles was assessed. RESULTS: Thirty-eight subjects had an RI ≤ 0.67 (30.4%), Group 1; 44 an RI > 0.67 and ≤0.76 (35.2%), Group 2; and 43 an RI ≥ 0.77 (34.4%), Group 3. In the univariate analysis, Group 1 was younger (P < .05), Group 2 had a shorter pretransplantation duration of dialysis (P < .05), and Group 1 had less tubular necrosis (P < .05). In the multivariate analysis, recipient age and tubular necrosis remained as independent predictors of RI values (P < .05). There was a nonlinear association between RI and dialysis duration. DISCUSSION: Our study confirms that RI has a linear, significant association with recipient age and tubular necrosis, and a nonlinear association with dialysis duration.

Phosphate mass removal during hemodialysis: a comparison between eKT/V-matched conventional and extended dialysis.

BACKGROUND AND OBJECTIVES: The control of hyperphosphatemia is an unmet need in dialysis care. Compared to conventional hemodialysis (cHD), extended hemodialysis (eHD) appears to more easily control blood phosphate levels in chronically dialyzed patients. Here, we sought to compare eKT/V-matched cHD and eHD procedures in order to quantify the contribution of dialysis prescription and time in the mass removal of phosphate. METHODS: Eight stable hemodialysis patients with negligible residual renal function underwent cHD and eHD sessions adjusted to provide the same eKT/V(urea). Total dialysate, total and hourly partial dialysate and blood samples were collected for comparison of mass extraction of urea, creatinine, and phosphate. RESULTS: Mean eKT/V(urea) was similar in eHD and cHD (1.30 vs. 1.28, p = nonsignificant). Likewise, mass removal of urea and creatinine during cHD and eHD were not significantly different. Conversely, phosphate mass removal was 40% higher with eHD as compared to cHD (1,219 ± 262 vs. 858 ± 186 mg, p = 0.015). Although hourly mass removal of phosphate was higher during cHD, the prolonged period of lesser but continuous removal was responsible for higher total phosphate elimination during eHD. CONCLUSION: In dialysis sessions matched to provide a similar eKT/V(urea), removal of phosphate increases by 40% when time is extended from 4 to 8 h. Urea-based adequacy models cannot be used to predict the amount of phosphorus removal during hemodialysis.

Extent and severity of chronic periodontitis in chronic kidney disease patients.

UNLABELLED: BACKGROUND AND OBJECTVE: Chronic inflammatory diseases have been investigated as a possible source of inflammation in chronic kidney disease patients; however, there is a shortage of information about the prevalence of periodontitis in such individuals. Therefore, the aim of this cross-sectional study was to determine the extent and severity of periodontitis in chronic kidney disease patients undergoing the following three different treatment modalities: predialysis; continuous ambulatory peritoneal dialysis (CAPD); and hemodialysis (HD); and to compare the findings with those from systemically healthy individuals. MATERIAL AND METHODS: Forty CAPD patients (mean age 52±12 years), 40 HD patients (mean age 50±10 years), 51 predialysis patients (mean age 54±11 years) and 67 healthy individuals (mean age 50±7 years) were examined. The periodontal examination included probing pocket depth, clinical attachment loss, bleeding on probing and presence of plaque. Patients with at least four sites with clinical attachment loss ≥6 mm were considered to have severe chronic periodontitis, and those with at least 30% of sites with clinical attachment loss ≥4 mm were considered to have generalized chronic periodontitis. RESULTS: Predialysis and HD patients had significantly more sites with clinical attachment loss ≥6 mm than healthy individuals. The CAPD patients had similar periodontal condition to healthy subjects. There were significantly more cases of severe chronic periodontitis in predialysis and HD patients. CONCLUSION: Predialysis and HD are associated with a higher prevalence of severe periodontitis compared with healthy individuals and CAPD patients.

Long-term outcome of renal transplantation at a university center in Rio de Janeiro between 1975 and 2000.

This study reports the 25-year experience of a single university center with respect to the impact of selected variables on long-term survival and half-life of 742 transplants. We calculated 1-, 5-, and 10-year Kaplan-Meier survival rates for grafts and patients, with separate analyses for HLA match and for each quinquennium. We also investigated the impact of cyclosporine administration and OKT3 induction. Global graft and patient survival rates were 85.2%, 61.0%, and 43.5% and 93.0%, 78.9%, and 66.6% for 1, 5, and 10 years, respectively. The half-life of 23.3 years for the 105 HLA-identical transplants was significantly better (P <.0001) than that for all other matches. Half-lives for 319 1-haplotype matched, 116 living-unrelated, and 153 cadaver grafts were 8.2, 5.7, and 5.6 years, respectively. No survival advantage was noted among these other matches. Introduction of cyclosporine in all non HLA-identical transplants and OKT3 induction for cadaver grafts conferred significant survival advantages compared with no use (P =.0002 and P =.009). There has been a continuous improvement in the long-term results in each quinquennium studied.

Reavaliaçåo por testes de 2a. geraçåo da prevalência de anticorpos antivírus da Hepatite C (soro e extrato sérico de papel de filtro) em uma unidade de transplante renal / Further evaluation of HCV antibody reactivities in serum and serum extracted from filter paper of patients and health workers in a renal transplant unit using 2nd generation tests

Objetivos: Reavaliar com testes de 2a. geraçåo a prevalência de anticorpos para o HCV em pacientes e equipe de saúde de uma unidade de transplante renal. Validar o uso de papel de filtro embebido em soro na pesquisa de anticorpos para o HCV. Método: Na classificaçåo dos pacientes quanto à presença ou nåo de hepatite foram utilizados dados clínicos e laboratoriais. A prevalência dos anticorpos para o HCV foi determinada em 79 transplantados renais e 63 profissionais da equipe de saúde por 3 testes ELISA de 2a. geraçåo (Ortho, UBI, Innogenetics). Utilizou-se o seguinte critério quanto às reatividades: positivo - repetidamente reativo nos 3 testes; negativo - nåo reativo nos 3 testes; indeterminado - reatividades discordantes. Para validar o uso de extrato sérico de papel de filtro, compararam-se os resultados obtidos em 46 pares de soro - correspondente extrato sérico. Resultados: Dados clínicos e/ou laboratoriais de hepatite, resolvida ou crônica, foram encontrados em 42 pacientes(53,16 por cento), enquanto que 29 (36,71 por cento) nåo tiveram ou nåo tem hepatite e 8 (10,13 por cento) nåo puderam ser definitivamente classificados. Os testes de 2a. geraçåo foram positivos em 40 pacientes (50,63 por cento) e indeterminados em 7 (8,86 por cento), em contraste com os resultados do teste de 1a. geraçåo (ABBOTT), positivo em 23 casos (29,11 por cento) e limitrofe em 5 (6,33 por cento). Dentre os profissionais da equipe de saúde, para os testes de 2a. geraçåo, houve 1 positivo (1,59 por cento) e indeterminados (3,17 por cento), enquanto que para o teste de 1a. geraçåo havia apenas um caso limítrofe. A prevalência global do HCV (anti-HCV)e HBV (HBsAg) nos pacientes foi de 77,22 por cento e na equipe de saúde 30,16 por cento (27,0 por cento neste último grupo positivo somente para anti-HBcAg). A concordância das reatividades nos 46 pares de soro-extrato sérico foi de 91,3 por cento. Conclusöes: Os testes de 2a. geraçåo classificaram 77,42 por cento (24/31) dos pacientes com hepatite NANB em contraste com os 61 por cento classificados anteriormente. Mesmo com o uso destes testes mais sensíveis, a prevalência do HCV na equipe de saúde foi bem mais baixa que a encontrada para o HBV. O alto índice de concordância dos resultados nos pares soro-extrato sérico sugere ser possível a utilizaçåo de papel de filtro embebido em soro ou sangue total nos levantamentos da prevalência de anticorpos para o HCV