The growing interest in the nutritional status of dialyzed patients arises from the fact that it plays an important role in the evolution, morbidity and mortality of renal patients. In the current study the effects have been assessed of a dietary intervention lasting 6 months, based on a food exchange list, on the nutritional status of a group of 49 hemodialysis patients as well as the different effects between men and women. The initial and final evaluation of the nutritional status was performed by estimating energy and nutrient intake with a 24 hour recall, determination of body composition by anthropometry, bioelectrical impedance and infrared interactance and biochemical measurements related to the nutritional status of the patients undergoing hemodialysis. At the end of the study, a significant increase was seen in the energy and macronutrient intake, which was more prominent in females. The body composition analysis showed a favourable evolution as compared to other studies; which was better in women who maintained the muscle mass stable and increased fat mass. The biochemical profile showed an increase of the C3 complement, while other markers such as amino acid profile and IGF I remained unchanged at the end of the study, being both similar in males and females. The dietary intervention was found to be useful in the prevention of the progression of malnutrition in these patients, apparently with a more beneficial effect on females.

English Abstract↗

PubMedDate not supplied

Haemostatic changes in systemic inflammatory response syndrome during continuous renal replacement therapy.

BACKGROUND: Endothelial damage and hemostatic imbalance play an important role in the evolution of the Systemic Inflammatory Response Syndrome (SIRS) into the Multiple Organ Dysfunction Syndrome (MODS). In Acute Renal Failure associated with SIRS, different types of Continuous Renal Replacement Therapies (CRRT) may give non-renal benefits by modifying the levels of some factors related to those disturbances. METHODS: Forty patients with SIRS-associated ARF were randomised to receive either continuous venovenous hemofiltration (CVVH) or continuous venovenous hemodiafiltration (CVVHDF) for the first 24 h. Afterwards the CRRT method was reversed. The group treated with CVVH moved to CVVHDF and that treated with CVVHDF to CVVH for the next 24 h. Plasma levels of: von Willebrand Factor (vWF), thrombomodulin, plasminogen activity inhibitor type 1 (PAI-1: antigen and activity), tissue type plasminogen activator (t-PA: antigen), prothrombin fragment 1+2 (F1+2) and thrombin-antithrombin complexes (TAT) were measured previously to CRRT (base-line), and after 24 and 48 hours of therapy. Multivariate ANOVA was the statistical method used. RESULTS: In the MANOVA study a significant decrease in PAI-1 activity during the treatment procedure was observed (horizontality p <0.05). PAI-1 antigen showed a tendency to decrease although without statististical significance. There were no significantly different changes in the other factors analysed during either CRRT (parallelism p >0.05). At the base-line point, all the factors were higher than normal values in healthy adults. CONCLUSIONS: The present study suggests that CRRT, in patients with SIRS, may promote a decrease in PAI-1 and consequently, a better outcome. There were no differences between the CVVH and the CVVHDF methods regarding the factors analysed. The present data confirms that there is an important endothelial and hemostatic dysfunction in SIRS from the early phases.

Acute Kidney Injury↗

PubMedDate not supplied

[The body composition of patients undergoing maintenance hemodialysis on an outpatient regimen].

Malnutrition is a common problem in patients with renal failure. The causes are multifactorial and include inadequate food intake, loss of nutrients into dialysate, intercurrent illness, uremic toxins and endocrine abnormalities. Therefore, it is very convenient to implement techniques for the assessment of the nutritional status in these patients. In this study, data referable to 32 subjects (17 men and 15 women) undergoing long-term hemodialysis therapy are presented. Measurements involved body weight, corrected by height and frame, arm-muscle area and triceps skinfold thickness. Our results show that about 40% of patients in stable maintenance hemodialysis are at risk of protein-calorie malnutrition, in such a way that muscle wasting is more frequent in male, while fat depletion occurs more commonly in female patients. These data are within the range of figures previously found in other hospitalized patients and confirm the need for an adequate evaluation of the nutritional status in this population in order to improve the global health care.

Ambulatory Care↗

PubMedDate not supplied

[Atheroembolic disease. Presentation of a case of multisystemic involvement and review of the literature].

The atheroembolic disease is an entity characterized by obstruction of multiple small arteries by cholesterol crystals. The incidence rises steeply with advancing age and following an invasive procedure involving arteries in patients with atherosclerosis. Actually it has a growing interest due to the increased frequency and to the lack of appropriate therapy. In this paper we report a clinical case of multiple system disease secondary to anticoagulant therapy in a 69 years old patient. We review the pathogenesis, clinical features, laboratory dates and pathology of the disease.

Aged↗

PubMedDate not supplied

[Nephrologic aspects of amyloidosis].

Amyloidosis is a syndrome characterized by intercellular deposition of a predominantly proteic substance in any organ and tissue. The kidney is one of the most affected organs and very important in as much as its involvements might produce the initial manifestations of the syndrome and could be the one responsible to establish the prognosis in many cases. In this paper, the most relevant features of the different types of renal amyloidosis (glomerular, vascular and tubulo-interstitial), and one special type of amyloidosis in patients on chronic hemodialysis and likewise other interesting aspects in the evolution of amyloidosis of kidney transplanted patients were reviewed. Emphasis was placed on renal vascular amyloidosis and on amyloidosis among patients on hemodialysis as these might deserve special clinical and etiopathogenic considerations according to our own experience.

Amyloidosis↗