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OBJECTIVE: The aim of this study was to examine the effect of volume status on the progressions of renal disease in normovolemic and hypervolemic patients with advanced non-dialysis-dependent chronic kidney disease (CKD) who were apparently normovolemic in conventional physical exam-ination. MATERIALS AND METHODS: This was a prospective interventional study performed in a group of stage 3-5 CKD patients followed up for 1 year. Three measurements were made for volume and renal status for every patient. The fluid status was assessed by a bioimpedance spectroscopy method. A blood pressure (BP) value > 130/80 mm Hg prompted the initiation or dose increment of diuretic treatment in normovolemic patients. RESULT: Forty-eight patients (48%) were hypervolemic. At the end of the 1-year follow-up, hypervolemic patients were found to have a significantly lower estimated glomerular filtration rate and higher systolic BP compared to baseline. Hypervolemia was associated with an increased incidence of death. CONCLUSION: We have shown that maintenance of normovolemia with diuretic therapy in normovolemic patients was able to slow down and even improve the progression of renal disease. Volume overload leads to an increased risk for dialysis initiation and a decrease in renal function in advanced CKD. Volume overload exhibits a stronger association with mortality in CKD patients.
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Diuréticos/uso terapêutico , Edema/complicações , Edema/terapia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Água Corporal , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal Crônica/mortalidade , Índice de Gravidade de Doença , Turquia/epidemiologiaRESUMO
PURPOSE: The issue of unidentified volume expansion is well recognized as a cause for resistance to antihypertensive therapy. The aim of study is to identify contribution of negative fluid balance to hypertension control and impact on endothelial and cardiac functions among primary hypertensive patients who do not have kidney failure. MATERIALS AND METHODS: This is a prospective interventional study with one-year follow-up. Preceded by volume status measurements were performed by a body composition monitor (BCM), the patients were put on ambulatory blood pressure monitoring for 24 hours. Then, echocardiographic assessments and flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) measurements were completed. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. RESULTS: At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower CIMT, left ventricle mass index, left ventricular end-diastolic diameter, mean systolic and diastolic BP, non-dipper patient ratio, and higher FMD. In negatively hydrated group, target organ damage significantly reduced during trial. CONCLUSIONS: The significance of negative hydration status with respect to blood pressure control, endothelial and cardiac functions within primary hypertensive patients who do not suffer from kidney failure has been demonstrated.
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Água Corporal/fisiologia , Endotélio/fisiopatologia , Ventrículos do Coração/patologia , Hipertensão/fisiopatologia , Equilíbrio Hidroeletrolítico/fisiologia , Adulto , Idoso , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Composição Corporal , Espessura Intima-Media Carotídea , Diástole , Diuréticos/uso terapêutico , Ecocardiografia , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos , SístoleRESUMO
AIM: Carpal tunnel syndrome (CTS) is one of the frequent problems of the patients who underwent hemodialysis (HD). The role of venous hypertension due to arteriovenous fistula (AVF) has not been clarified completely; therefore, we aimed to investigate the role of venous hypertension due to AVF in hemodialysis patients who had CTS. PATIENTS AND METHODS: We included 12 patients who had been receiving HD treatment for less than 8 years and the newly diagnosed CTS patients with the same arm of AVF. All patients were diagnosed clinically and the results were confirmed by both nerve conduction studies and electromyography. Open carpal tunnel release surgery was performed on all of them. Venous pressure was measured in all patients before and after two weeks of surgery. RESULTS: There were significant differences before and after the surgery with regard to pressures (P > 0.05). After the surgery, all carpal ligament specimens of the patients were not stained with Congo red for the presence of amyloid deposition. CONCLUSION: Increased venous pressure on the same arm with AVF could be responsible for CTS in hemodialysis patients. Carpal tunnel release surgery is the main treatment of this disease by reducing the compression on the nerve.
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Síndrome do Túnel Carpal/etiologia , Hipertensão/etiologia , Ligamentos Articulares/patologia , Placa Amiloide/etiologia , Diálise Renal/efeitos adversos , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/etiologia , Síndrome do Túnel Carpal/patologia , Síndrome do Túnel Carpal/cirurgia , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Placa Amiloide/complicaçõesRESUMO
The aim of this study is to evaluate the oxidative stress in predialysis, hemodialysis (HD) and peritoneal dialysis patients and to test the effects of antihypertensive drugs and volume control on oxidative stress parameters. The study was composed of five groups as follows: control group (n = 30), predialysis group (n = 30), peritoneal dialysis group (n = 30), hemodialysis group, (normotensive with strict volume control, n = 30), hemodialysis group (normotensive with medication, n = 30). Plasma malondialdehyde (MDA), erythrocyte superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSHPx) and routine biochemical parameters were studied in all patients. Hemodialysis patients with strict volume control (HDvc) had lower levels of MDA than other patient groups (p < 0.001), and CAT, SOD values had highest level other patient groups (p < 0.001). The treatment of hypertension with strict volume control in chronic renal failure patients causes less damage to the antioxidant capacity.
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BACKGROUND: We aimed to describe the thiamine status in hospitalized hypervolemic heart failure (HF) and/or renal failure (RF) patients treated with furosemide and to investigate whether there was a difference in furosemide-related thiamine deficiency between patients with RF and HF. METHODS: Patients who were diagnosed as hypervolemia and treated with intravenous furosemide (at least 40mg/day) were included in this prospective observational study. Whole blood thiamine concentrations were measured 3 times during hospital follow-up of patients. RESULTS: We evaluated 61 hospitalized hypervolemic patients, of which 22 (36%) were men and 39 (64%) were women, with a mean age of 69.00±10.39 (45-90) years. The baseline and post-hospital admission days 2 and 4 mean thiamine levels were 51.71±20.66ng/ml, 47.64±15.43ng/ml and 43.78±16.20ng/ml, respectively. Thiamine levels of the hypervolemic patients decreased significantly during the hospital stay while furosemide treatment was continuing (p=0.029). There was a significant decrease in thiamine levels in patients who had HF (p=0.026) and also, thiamine was significantly lower in HF patients who had previously used oral furosemide before hospitalization. However, these findings were not present in patients with RF. CONCLUSIONS: Thiamine substantially decreases in most hypervolemic patients receiving intravenous furosemide treatment during the hospital stay. Thiamine levels were significantly decreased with furosemide treatment in especially HF patients, but the decrease in thiamine levels did not detected at the same rate in RF patients. Diuretic-induced thiamine loss may be less likely in RF patients, probably due to a reduction in excretion.
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Insuficiência Cardíaca , Insuficiência Renal , Deficiência de Tiamina , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Furosemida/efeitos adversos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Deficiência de Tiamina/complicações , Deficiência de Tiamina/tratamento farmacológico , Deficiência de Tiamina/induzido quimicamente , Tiamina/uso terapêutico , Tiamina/efeitos adversosRESUMO
BACKGROUND: On February 6, 2023, an earthquake occurred in Kahramanmaras, Turkey, resulting in loss of life, injuries, and the displacement of thousands of people. The aim of this study is to determine the factors affecting amputation and fasciotomy decisions in patients with crush syndrome, along with clinical laboratory parameters. MATERIALS AND METHODS: The study included patients over 18 years of age who presented with crush injuries and exhibited systemic symptoms. Inclusion criteria comprised patients with creatine kinase (CK) levels exceeding 1,000 IU/L, oliguria (urine output less than 400 mL per day), elevated blood urea nitrogen (BUN) levels surpassing 40 mg/dL, serum creatinine exceeding 1.5 mg/dL, potassium levels over 6 mEq/L, phosphorus levels surpassing 8 mg/dL, and serum calcium levels below 8 mg/dL. Multiple parameters were evaluated, including blood glucose, serum sodium, potassium, calcium, phosphorus, BUN, creatinine, uric acid, CK, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, direct bilirubin, prothrombin time (international normalized ratio (INR)), urinalysis, C-reactive protein (CRP), venous blood gas, ECG, and chest radiography. RESULTS: Following the Maras earthquake, a total of 3,184 patients were admitted to our hospital within the first seven days. Out of these patients, 2,216 received outpatient treatment, 639 were hospitalized in the general ward, and 128 were admitted to the intensive care unit. Among the admitted patients, 237 were diagnosed with crush syndrome, with 126 being male and 111 being female. The average duration of being trapped under debris was eight hours, ranging from four to 36 hours. In the study population, extremity trauma was observed in 84 patients, thoracic trauma in 32 patients, and abdominal trauma in 20 patients. Erythrocyte replacement was administered to 123 patients, while fresh frozen plasma was given to 69 patients, for a total of 1008 units utilized. Mannitol infusions were provided to 58 patients, while bicarbonate infusions were administered to 116 patients. Among the cohort, 71 patients underwent dialysis, with nine of them receiving hemodialysis along with mannitol. Additionally, 67 patients experienced stage 3 acute kidney injury, and 41 patients were deceased. None of the patients required permanent hemodialysis. CONCLUSION: Earthquakes are considered to be one of nature's most significant and inevitable disasters. While it is impossible to prevent them, effective management strategies are crucial in mitigating the ensuing chaos and reducing casualties. In order to achieve this, it is imperative to draw lessons from past seismic events and apply appropriate treatment protocols to the affected individuals.
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BACKGROUND: Elevated C-reactive protein (CRP) levels as an inflammatory marker have been associated with poor outcomes in patients with chronic kidney disease (CKD). However, its single assessment may not reflect clinical significance before an adverse clinical endpoint. We studied the CRP level trajectories, which may be related with the intensity of the inflammatory process, and its association with time-to-first hospitalization in CKD. METHODS: A cohort of 739 patients with stage 3-4 CKD were retrospectively observed for seven years. The time-to-event outcome was all-cause hospitalization. Clinical and laboratory features were measured at baseline. Longitudinal changes in naturally logged CRP levels were modeled using the Joint Longitudinal-Survival model adjusted with baseline covariates. RESULTS: Logged CRP changes were evaluated with a median measurement (interquartile range) of 4 (2, 7), during a median (interquartile range) follow-up of 2.3 (1.2, 3.9) years. The estimated mean increase in logged CRP was 0.35 mg/L per year. 299 (40.5%) patients reached the endpoint, and increase in logged CRP with time was associated with increased risk of hospitalization (HR 1.96; 95% CI 1.05-3.66; p = 0.034), but baseline logged CRP did not have a significant effect on the time-to-first hospitalization (HR 0.98; 95% CI 0.85-1.13; p = 0.736). CONCLUSION: All-cause hospitalization was associated significantly with CRP trajectories. Temporal evolutions of these repeatedly measured biomarkers might predict clinical outcomes in patients with CKD and may be useful for individual risk profiling. Furthermore, early management may provide an opportunity to better patient survival.
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Proteína C-Reativa/análise , Hospitalização/estatística & dados numéricos , Insuficiência Renal Crônica/sangue , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de TempoRESUMO
Serum albumin is a major determinant of hospitalization in patients with end-stage renal disease (ESRD). Previous reports generally use the Poisson model to evaluate the relationships between outcome and response variables. However, hospitalization data are often overdispersed, and few studies using appropriate methods exist in the literature.This retrospective cohort study included 426 patients with ESRD receiving hemodialysis treatment between 2014 and 2018. Using a negative binomial regression model with hierarchical multivariable adjustments, we investigated the relationship between serum albumin, hospital admissions, and total hospitalization days. Mean age and mean baseline serum albumin levels were 64.7 ± 11 years and 3.5 ± 0.5 g/dL, respectively. At least one hospitalization was identified in 402 (94%) patients. The incidence rate was 1.48 (95% CI, 1.41-1.56) admissions per patient-year during the follow-up period of 5 years. A negative linear association was observed between serum albumin and hospitalization frequency. Hospitalization rates (95% CI) were 1.81 (1.65-1.98), 1.44 (1.3-1.59), 1.36 (1.22-1.51), and 1.33 (1.2-1.48) per patient-year in serum albumin levels ≤3, 3.1 to ≤3.3, 3.4 to ≤3.7, and ≥3.8 g/dL, respectively. Case mix-adjusted incidence rate ratio was 0.82 (95% CI, 0.70-0.94), while it was robust to further adjustments for malnutrition and inflammation markers. Similar results were observed in hospitalization days and time to the first hospitalization. These findings, which result from the negative binomial model using overdispersed data, suggest that lower serum albumin is related to increased hospitalization rates and hospital days in incident hemodialysis patients.
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Hospitalização/estatística & dados numéricos , Falência Renal Crônica/terapia , Diálise Renal/métodos , Albumina Sérica/metabolismo , Idoso , Biomarcadores/metabolismo , Estudos de Coortes , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Estudos RetrospectivosRESUMO
Immunoglobulin M nephropathy (IgMN) is a glomerular disease that may be identified in all age groups, but children and young adults appear to have been affected more frequently in some series. The clinical picture could differ from hematuria to rapidly progressive glomerulonephritis. The main characteristics in pathologic examination are mesangial hypercellularity with a diffuse and granular immunoglobulin M deposition in the glomerular structure. To date, a standardized protocol has not been proposed for IgMN treatment. Systemic corticosteroids, calcineurin inhibitors, cyclophosphamide, and rituximab were agents reported in the literature. We present a 30-year-old woman admitted to the hospital for edema in the lower extremities at the 31st week of pregnancy. She had one abortus previously, and this was her second pregnancy. Renal biopsy performed after delivery was reported as IgMN with mesangial proliferation. She received 1 mg/kg/day prednisone therapy achieving complete remission. This report is the first case of IgMN developed in pregnancy.
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BACKGROUND: Diabetes mellitus (DM) increases mortality and morbidity in patients with coronavirus disease (COVID-19). In this study, it was aimed to assess factors influencing on COVID-19 pneumonia in hospitalized patients with diabetes and association with oral anti-diabetic drugs. MATERIALS AND METHODS: This cross-sectional study included 432 patients with type 2 diabetes mellitus diagnosed with COVID-19. Data regarding clinical characteristics, demographic characteristics, intensive care unit (ICU) rate in patients admitted to ICU, laboratory results on day 1 and 7, thoracic computed tomography (CT) findings and oral anti-diabetic drugs used were extracted from medical records. In all patients, 75-days mortality was recorded. Data were assessed independently. RESULTS: There was pneumonia in 386 (89.4%) of 432 patients with diabetes. The risk for pneumonia was markedly higher in patients on DPP-4 inhibitors; however, there was no significant among other oral anti-diabetic groups and subgroups. In addition, elevated CRP was linked to the increased risk for pneumonia. Only patients in the pneumonia group had SGLT-2 inhibitor use. During follow-up, 91 patients died. In Cox regression analysis, low Glasgow Coma Scale score, and increased lactate dehydrogenase levels were identified as significant independent risk factors for mortality. CONCLUSION: The study indicated that DPP-4 inhibitor used and elevated CRP level were associated with pneumonia development. Only patients in the pneumonia group had SGLT-2 inhibitor use. No oral anti-diabetics was found to be associated with COVID-19 related death.
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COVID-19 , Diabetes Mellitus Tipo 2 , Preparações Farmacêuticas , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , SARS-CoV-2RESUMO
BACKGROUND: Increased blood pressure variability (BPV) is associated with higher cardiovascular risk. The association between BPV and fluid status in hypertensive patients has not been investigated so far. The aim of the present study was to determine the contribution of fluid balance to BPV and impact on endothelial and cardiac functions among primary hypertensive patients. METHODS: This is a prospective interventional study conducted in primary hypertensive patients with one-year follow-up. Volume status measurements by a body composition monitor, ambulatory blood pressure (BP) monitoring, echocardiographic and carotid intima-media thickness (CIMT) measurements were performed at enrollment and at twelfth. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. Patients in other group were positively hydrated (hypervolemic) at enrollment, antihypertensive drugs other than diuretics (vasodilator agents) were added or intensified according to the BP monitoring. Average real variability (ARV) index was used for establishing the prognostic significance of BPV. RESULTS: The study population consisted of 50 patients with a mean age of 54.5±8.8 years. At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower BP, CIMT, left ventricle mass index (LVMI) and systolic and diastolic ARV. More weight gain and higher systolic BP were major risk factors of high systolic ARV. Patients who have improvement in CIMT and LVMI were considered as target organ damage (TOD) recovery present. In negatively hydrated group, TOD significantly reduced during trial. In patients who have TOD recovery, BPV significantly more reduced like systolic and diastolic BP. Significant risk factors associated with the presence of TOD were 24h systolic BP and daytime and night time diastolic ARV and night time diastolic BP. CONCLUSION: Addition of diuretic to established treatment or intensified diuretic treatment and keeping patients in negative hydration status resulted in reduction in BPV at twelfth month of follow-up. More weight gain and higher systolic BP are major risk factors of high systolic ARV, but not hypervolemia. BPV, especially diastolic ARV, was significantly associated with TOD.
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Pressão Sanguínea , Hipertensão/fisiopatologia , Equilíbrio Hidroeletrolítico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: Linagliptin does not require dose adjustment in diabetes mellitus patients with chronic kidney disease (CKD). But, renal effects of linagliptin are not clear. Our aim was to examine the effect of linagliptin on renal disease progression in only insulin dependent type 2 diabetes mellitus (DM) patients with CKD. METHODS: Stage 3-4 CKD patients were randomized into 2 groups in this prospective randomized controlled study. In the first group, linagliptin 5mg was added in addition to the background insulin therapy. In the second group, patients continued their insulin therapy. Patients were followed up at 3-month intervals for one year. RESULTS: The study population consisted of 164 patients (90 patients in linagliptin group, 74 patients in other group) with a mean age of 67.5±8.8 years. eGFR significantly increased in linagliptin group (p=0.033), but decreased in other group (p=0.003). No significant change was observed in total insulin dose in linagliptin group (p=0.111), but in other group, total insulin dose significantly increased (p<0.001). Proteinuria levels decreased in both groups, but there was no significant change. In the multiple logistic regression analysis, male gender and proteinuria emerged as variables that showed significant association with increased risk and the use of linagliptin emerged as variable that showed significant association with decreased risk for CKD progression. CONCLUSION: Linagliptin in DM patients with CKD was able to improve renal progression without significant effect on proteinuria and glucose control. With regard to treating diabetic nephropathy, linagliptin may offer a new therapeutic approach.
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Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Progressão da Doença , Linagliptina/uso terapêutico , Insuficiência Renal Crônica/tratamento farmacológico , Idoso , Diabetes Mellitus Tipo 2/complicações , Inibidores da Dipeptidil Peptidase IV/administração & dosagem , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Insulina/administração & dosagem , Insulina/uso terapêutico , Linagliptina/administração & dosagem , Masculino , Estudos Prospectivos , Proteinúria/tratamento farmacológico , Análise de Regressão , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia , Fatores SexuaisRESUMO
PURPOSE: Nutritional status and micronutrient levels of end stage renal disease (ESRD) patients may vary depending on the mode of renal replacement therapy (RRT). We aimed to compare the effects of hemodialysis, peritoneal dialysis (PD) and renal transplantation (RT) on micronutrient levels and nutritional status in ESRD patients. PATIENTS AND METHODS: A total of 77 ESRD patients who had not received RRT were included in this prospective longitudinal study. All ESRD patients underwent a blood serum analysis that assessed the micronutrients such as selenium, copper, zinc, chromium, retinol, thiamine and vitamin B6 as well as a nutritional status assessment. After the baseline assessments and the initiation of RRT was accomplished, all patients were followed for 6 months. RESULTS: The study showed significant improvements in subjective global assessment scores (percentage increases in score A were 26.6 and 36.6; pâ¯=â¯0.039 and pâ¯=â¯0.001; respectively), mid-arm circumference and the skin-fold thicknesses (pâ¯<â¯0.001, pâ¯<â¯0.001; respectively) in the RT and hemodialysis groups. The examinations at sixth month revealed a significant increase in body weight (4.8â¯kg; pâ¯=â¯0.002) and albumin levels (0.6â¯g/dL; pâ¯<â¯0.001) in only RT group. Zinc, thiamin and vitamin B6 were the most deficient micronutrients (44.1 %, 24.7 % and 35.1 %; respectively) in ESRD patients. There was a significant increase in selenium and retinol levels (pâ¯=â¯0.020 and pâ¯<â¯0.001; respectively) but a significant decrease in thiamin levels (pâ¯=â¯0.041) in RT patients. A significant increase in retinol levels (pâ¯=â¯0.028) and a significant decrease in thiamin levels (pâ¯=â¯0.022) was observed in the hemodialysis patients. However, no significant change in micronutrient levels was observed in the PD patients. CONCLUSION: The results support the recommendation that ESRD patients should be supplemented with water-soluble vitamins, especially thiamine and vitamin B6, and trace elements, especially zinc. RT appears to be superior to other modes of RRT when examining SGA score, anthropometric measurements, albumin and micronutrient levels.
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Falência Renal Crônica/terapia , Transplante de Rim , Micronutrientes/sangue , Estado Nutricional , Diálise Renal , Adulto , Feminino , Humanos , Falência Renal Crônica/sangue , Estudos Longitudinais , Masculino , Micronutrientes/deficiência , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Cognitive dysfunction is a well-known complication of chronic renal failure that is evident in 30% of hemodialysis (HD) patients. However, the pathogenesis of this dysfunction is unknown. Left ventricular hypertrophy could develop in hypertensive HD patients without establishing normovolemia. Our aim was to evaluate the effect of strict volume control by salt restriction and ultrafiltration on cognitive functions in HD patients. This cross-sectional study was composed of 22 HD patients who were normotensive by applying a strict volume control, 24 HD patients who were normotensive by receiving anti-hypertensive drugs, and 20 healthy controls. The strict volume control was defined as managing of blood pressure control by strict salt restriction and insistent ultrafiltration. P300 recording as an indicator of cognitive disfunction was measured when blood pressures were reached at target level at the end of six-month follow-up period. In all patients, dimensions of the heart were evaluated with echocardiography on an interdialytic day. The cardiothoracic ratio and echocardiographic dimensions were significantly lower in patients with strict volume control. P300 amplitudes were significantly lower in patients on antihypertensive drugs than in patients with strict volume control (9.5 +/- 5.1 versus 11.3 +/- 5.4 muV). P300 latency was longer in patients on antihypertensive drugs than in the control group and patients with strict volume control (359.9 +/- 39.6 versus 345.6 +/- 36.7 ms). Our results suggest that hypervolemia may be one of the causal and potentially modifiable factors of cognitive dysfunction. Strict volume control may have beneficial effects on cognitive functions in hemodialysis patients.
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Transtornos Cognitivos/terapia , Dieta Hipossódica , Falência Renal Crônica/terapia , Ultrafiltração , Desequilíbrio Hidroeletrolítico/terapia , Adulto , Líquidos Corporais/fisiologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/fisiopatologia , Estudos Transversais , Feminino , Hidratação , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodos , Desequilíbrio Hidroeletrolítico/etiologiaRESUMO
BACKGROUND: The objective of this study was to determine the effects of strict volume control and nondipper situation on cardiovascular disease in chronic hemodialysis patients. METHODS: This study is an observational and cross-sectional study including 62 patients with normotensive chronic hemodialysis using no antihypertensive drugs. A series of measurements including ambulatory blood pressure monitoring, left ventricular mass index by echocardiography, common carotid artery intima-media thickness by ultrasound, and body fluids by bioimpedance analysis were conducted for all subjects. RESULTS: The patients were divided into two groups as dippers and nondippers according to their ambulatory blood pressure monitoring results. Average 48 h systolic, diastolic, and mean arterial blood pressure and nocturnal systolic, diastolic, and mean arterial blood pressure were significantly different between the dipper and nondipper groups (p<0.05). Before and after dialysis, extracellular fluid/intracellular fluid and extracellular fluid/dry body weight ratios were significantly higher in the nondipper group. Left ventricle mass index and interventricular septum thickness were significantly higher in the nondipper group (p<0.05). Left ventricle ejection fraction was significantly lower and common carotid artery intima-media thickness was higher in the nondipper group with a statistical significance (p<0.05). A two-predictor logistic model was fitted to the data to predict the comparability of dippers and nondippers. CONCLUSION: According to logistic regression analysis, the odds ratio for daytime diastolic blood pressure indicates that nondippers are 0.45 times more likely to have high blood pressure than dippers in daytime. But in night time, nondippers are about 2.55 times more likely to have high blood pressure comparing to dippers. An important finding of this study is that nondipping pattern is associated with cardiac hypertrophy and lower left ventricle ejection fraction in dialysis of patients with no hypertension. The results also suggest that applying strict volume control to achieve a normal blood pressure alone is not sufficient to reduce the risk of cardiovascular morbidity and mortality if the patients do not have a dipper status of nocturnal blood pressure.
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Cardiac adverse effects of intravenous pulse methylprednisolone administration are well known, but there is little information about the cardiac side effects of oral methylprednisolone in the literature. We present a 41 year-old man with membranoproliferative glomerulonephritis in whom developed atrial fibrillation after oral methylprednisolone therapy.
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Fibrilação Atrial/induzido quimicamente , Glomerulonefrite Membranoproliferativa/tratamento farmacológico , Glucocorticoides/efeitos adversos , Metilprednisolona/efeitos adversos , Administração Oral , Adulto , Glucocorticoides/administração & dosagem , Humanos , Masculino , Metilprednisolona/administração & dosagemRESUMO
Background: We aimed to describe the thiamine status in hospitalized hypervolemic heart failure (HF) and/or renal failure (RF) patients treated with furosemide and to investigate whether there was a difference in furosemide-related thiamine deficiency between patients with RF and HF. Methods: Patients who were diagnosed as hypervolemia and treated with intravenous furosemide (at least 40mg/day) were included in this prospective observational study. Whole blood thiamine concentrations were measured 3 times during hospital follow-up of patients. Results: We evaluated 61 hospitalized hypervolemic patients, of which 22 (36%) were men and 39 (64%) were women, with a mean age of 69.00±10.39 (4590) years. The baseline and posthospital admission days 2 and 4 mean thiamine levels were 51.71±20.66ng/ml, 47.64±15.43ng/ml and 43.78±16.20ng/ml, respectively. Thiamine levels of the hypervolemic patients decreased significantly during the hospital stay while furosemide treatment was continuing (p=0.029). There was a significant decrease in thiamine levels in patients who had HF (p=0.026) and also, thiamine was significantly lower in HF patients who had previously used oral furosemide before hospitalization. However, these findings were not present in patients with RF. (AU)
Antecedentes: Nos propusimos describir el estado de la tiamina en pacientes hospitalizados con insuficiencia cardíaca (IC) y/o insuficiencia renal (IR) hipervolémica tratados con furosemida, e investigar si había una diferencia en la deficiencia de tiamina relacionada con la furosemida entre los pacientes con IR y con IC. Métodos: En este estudio observacional prospectivo se incluyeron pacientes con diagnóstico de hipervolemia y tratados con furosemida intravenosa (al menos 40 mg/día). Se midieron las concentraciones de tiamina en sangre total 3 veces durante el seguimiento hospitalario de los pacientes. Resultados: Se evaluaron 61 pacientes hipervolémicos hospitalizados, de los cuales 22 (36%) eran hombres y 39 (64%) eran mujeres, con una edad media de 69,00±10,39 (45-90) años. Los niveles medios de tiamina en la línea de base y tras el ingreso hospitalario en los días 2 y 4 fueron de 51,71±20,66 ng/ml, 47,64±15,43 ng/ml y 43,78±16,20 ng/ml, respectivamente. Los niveles de tiamina de los pacientes hipervolémicos hipervolemia disminuyeron significativamente durante la estancia en el hospital mientras se mantenía el tratamiento con furosemida furosemida (p = 0,029). Hubo una disminución significativa de los niveles de tiamina en los pacientes que tenían IC (p = 0,026) y también, la tiamina fue significativamente menor en los pacientes con IC que habían habían utilizado previamente furosemida oral antes de la hospitalización. Sin embargo, estos hallazgos no se presentes en los pacientes con IC. (AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Insuficiência Cardíaca , Insuficiência Renal , Deficiência de Tiamina , Furosemida/uso terapêutico , Estudos ProspectivosRESUMO
BACKGROUND/PURPOSE: One of the most common complications of the peritoneal dialysis (PD) is the infection of the exit site of the peritoneal catheter. The aim of the present study was to evaluate the efficacy of the subcutaneous gentamicin injection around the cuff as a part of routine treatment of the resistant exit site infection (ESI). METHODS: If the exit site remains infected after a 2-week systemic antibiotics treatment, it is defined as resistant ESI. In these cases, systemic antibiotics were discontinued and a subcutaneous 40-mg gentamicin injection was administered around the external cuff of the PD catheter every 3 days. A total of three or four injections were given to each patient. RESULTS: A subcutaneous gentamicin injection was administered around the cuff in thirteen patients for the treatment of resistant ESI over a 2-year period. The median follow-up time in cured patients was 12 months. Eleven of the thirteen patients had been apparently cured of their resistant ESI, with no recurrence. None of the patients had a gentamicin-resistant species. Subcutaneous gentamicin-related adverse effect was not observed in any patient. CONCLUSION: Subcutaneous gentamicin injection around the cuff is a well-tolerated and effective strategy for treating resistant ESI. To gain widespread approval of this therapy and reach a consensus about ESI management, additional studies are needed.
RESUMO
BACKGROUND: Damage in large arteries, characterized by increased intima-media thickness and decreased compliance, is frequent in hemodialysis patients and increases cardiovascular morbidity and mortality. Since volume overload and hypertension may accelerate atherosclerosis in patients with chronic renal failure, the aim of this 1-year study was to assess whether strict volume control would improve structural and functional abnormalities of the com-mon carotid artery in hypertensive hemodialysis patients. METHODS: We conducted a prospective study (n=16) for 1 year to investigate the effect of strict volume control on intima-media thickness and compliance of the common carotid artery. Intima-media thickness was assessed by echocardiography. RESULTS: All patients were normotensive without antihypertensive drugs at the end of follow-up. During the follow-up period, continuous efforts were made to further reduce blood pressure if necessary. This resulted in a gradual further improvement in several of the measured parameters. The cardiac index did not significantly change throughout the study. The most important finding was a marked decrease in the intima-media thickness of the common carotid artery (p<0.000). This decrease in intima-media thickness was accompanied by significant amelioration in the arterial compliance of the common carotid artery (p<0.000) and consequently of the systemic vascular resistance index (p<0.004). CONCLUSION: In conclusion, a strict volume control strategy effectively improves vascular abnormalities. Moreover, this study demonstrates the possible role of vascular stiffening in blood pressure regulation in patients with chronic renal failure.
Assuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/fisiopatologia , Dieta Hipossódica , Hemodiafiltração , Hipertensão/terapia , Falência Renal Crônica/terapia , Adolescente , Adulto , Idoso , Complacência (Medida de Distensibilidade) , Feminino , Seguimentos , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Falência Renal Crônica/complicações , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/fisiopatologia , Túnica Média/diagnóstico por imagem , Túnica Média/fisiopatologia , UltrassonografiaRESUMO
BACKGROUND: In some haemodialysis patients, blood pressure increases during the dialysis session despite ultrafiltration (UF). METHODS: We investigated six such patients who were not responsive to hypotensive drugs. Their echocardiograms were obtained prior to and during the dialysis session. RESULTS: After the mean 2520 +/- 1698 (4.5 +/- 2.3% of BW) ml of fluid was removed, the cardiac systolic function parameters significantly improved and maximum mean arterial pressure rose (from 107 +/- 5 to 118 +/- 6 mmHg, p < 0.027). This increase in blood pressure was accompanied by an increase in cardiac index (from 3.8 +/- 0.6 to 4.8 +/- 1.1 L/min/m2, p < 0.027). With continuing UF, after a mean fluid removal of 4133 +/- 1622 (7.5 +/- 2.1% of BW) ml, normal blood pressure was achieved in all patients. Previously increased ejection fraction and fractional shortening decreased. End-diastolic volume significantly decreased from 98 +/- 34 to 78 +/- 35 ml/m2 indicating normovolemia. This decrease in blood pressure was accompanied by a return of cardiac index to normal values (from 4.8 +/- 1.1 to 3.1 +/- 0.8 L/min/m2, p < 0.027). There was a positive correlation between mean arterial pressure and cardiac index (r = 0.56, p = 0.017). CONCLUSION: We hypothesize that our patients had passed the top of the Frank-Starling curve and were on the descending limb at the initial examination. With UF, patients first shifted to the left and upward on the curve. With further UF, they came down the ascending limb of the curve. In conclusion, paradoxical blood pressure rise during UF is caused by increased cardiac output, mediated by volume overload and can be treated by intensified UF.