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Biomedical subjects

A Rodríguez-Carmona

Publications and source records attributed to A Rodríguez-Carmona.

At least 19 recordsLinked to original sources
PubMed2000

Hyperleptinemia is not correlated with markers of protein malnutrition in chronic renal failure. A cross-sectional study in predialysis, peritoneal dialysis and hemodialysis patients.

BACKGROUND: Serum leptin levels are increased in chronic renal failure (CRF) and may potentially contribute to protein malnutrition in this disorder. METHOD: Following a cross-sectional design, we performed a nutritional survey in a wide sample of uremic patients treated conservatively (n = 87), with peritoneal dialysis (n = 71) and with hemodialysis (n = 53). Then, we analyzed the correlation between serum leptin levels and markers of protein malnutrition. We used a multivariate approach, taking into consideration the confounding effect of other factors on the correlation between hyperleptinemia and protein malnutrition. MAIN RESULTS: Both univariate and multivariate analysis disclosed a poor correlation between hyperleptinemia and markers of protein malnutrition. In fact, there were trends to a positive correlation between leptinemia and body protein stores, as estimated from the scrutinized markers. Persistence of the basic correlation between general intake, fat mass and leptin in CRF could partially explain these findings, but neither a negative correlation between leptin levels nor protein nutritional state could be disclosed after controlling for this factor. CONCLUSIONS: Our results do not support a first-line role for hyperleptinemia in the genesis of protein malnutrition of uremia.

Adult↗
PubMed2000

Natural anti-alpha-galactosyl antibodies in patients undergoing peritoneal dialysis and hemodialysis.

Anti-alpha-galactosyl antibodies (anti-Gal) seemingly mediate rejection of pig organs transplanted into humans and Old World monkeys. These natural antibodies appear to be produced by a subpopulation of B cells residing in the peritoneum. Therefore, peritoneal dialysis (PD) may have an impact on anti-Gal levels. In this cross-sectional study, blood anti-Gal levels were quantified by ELISA in 17 patients undergoing PD and 18 patients undergoing hemodialysis (HD), and the results were compared with those from a control group of 30 healthy blood donors. The effects of the mode of dialysis therapy and other epidemiologic variables on anti-Gal levels were also evaluated. The PD and HD patients were comparable with regards to age, sex, percentage having diabetes, time on dialysis, distribution of blood groups, and total serum levels of immunoglobulins A (IgA), G (IgG), and M (IgM). In patients and controls, IgG anti-Gal levels were not significantly different, but IgM anti-Gal levels were significantly lower in both PD and HD patients compared with controls. A nonsignificant trend toward lower IgM anti-Gal levels in PD patients compared with HD patients was also observed. IgG anti-Gal levels correlated positively with time on dialysis in the HD patients, but not in the PD patients. IgG anti-Gal levels also were found to be markedly elevated in three patients with chronic liver disease, but no other scrutinized variable appeared to influence IgG or IgM anti-Gal levels.

Antibodies↗
PubMed2000

Prevalence of microbial colonization in removed peritoneal catheters: a prospective study.

We conducted a prospective bacteriologic study of 89 peritoneal catheters removed from 77 peritoneal dialysis patients. Reasons for catheter removal included severe peritonitis (n = 36, Group A), persistent exit-site infection (n = 29, Group B), and dormant, seemingly uninfected catheters (n = 22, Group C). We studied the external cuff (EC) and internal cuff (IC) as well as the catheter tip. In Group A, microbial growth was seen in 86.1% of ECs, 66.7% of ICs, and 67.6% of tips. In cases of positive isolation, concordance was 91.7% IC versus EC, 84.2% IC versus tip, and 80.0% EC versus tip. The peritonitis agent was recovered from 61.1% of ECs, 50.0% of ICs, and 55.6% of tips. In Group B, colonization was seen in 72.4% of ECs, 44.8% of ICs, and 31.0% of tips. When an isolation was obtained from both EC and IC, concordance was 81.8%. The exit-site infection agent was recovered from 69% of ECs and 24% of ICs. In Group C, microbial growth was observed in 77.3% of ECs, 45.5% of ICs, and 31.8% of tips. Gram-positive bacteria predominated, with the same bacteria colonizing EC and IC in 66.7% of cases. In conclusion, removed peritoneal catheters present a high prevalence of extensive microbial colonization, even in the absence of overt infection.

Bacteria↗
PubMed1999

Early proteinuria in renal transplant recipients treated with cyclosporin.

PURPOSE: To establish the risk profile for the development of proteinuria in the first months after renal transplantation and to disclose the prognostic significance of this finding. DESIGN: We conducted an observational historic cohort study. SETTING: We conducted the study in a tertiary care hospital renal transplantation unit covering a potential population of approximately 2 million. We made extensive use of suboptimal donors. POPULATION: In our unit, 560 cadaveric renal transplants were performed between January 1988 and June 1997, under Cyclosporine immunosuppression, with a minimum follow up of 1 year. METHOD: The risk profile analysis explored early clinical factors reported to be related to the late course of renal transplantation. The study of the prognostic significance of proteinuria included survival analysis and correlation with late markers of graft dysfunction, taking into consideration the intensity and persistence of early proteinuria. A multivariate approach was used in all cases. RESULTS: Early proteinuria was strongly associated with delayed graft function (odds ratio [OR] 1.03/day of dialysis), acute rejection (OR 1.7 for steroid-sensitive and 6.2 for steroid-resistant rejection), renal transplant to a hypersensitized recipient (OR 2.5), and pediatric (<5 years)(OR 4.1) or older (>60 years)(OR 3.0) donors. The predictive model for persistency of proteinuria was very similar, whereas transient proteinuria could not be adequately modeled. Increasing intensity of proteinuria was strongly associated with poor patient and graft survival. Persistent, but not transient, proteinuria supported this relationship. CONCLUSIONS: Proteinuria appearing early after renal transplantation is strongly associated with delayed graft function, acute rejection, and the use of pediatric or older donors. Whatever its background, proteinuria is a strong predictor of poor patient and graft survival. This effect is directly related to the intensity and persistence of the disorder.

Adolescent↗
PubMed1999

Hyperleptinemia in uremic patients undergoing conservative management, peritoneal dialysis, and hemodialysis: A comparative analysis.

We performed a cross-sectional study in a wide sample of patients with chronic renal failure undergoing conservative therapy (CTh) (n = 79), peritoneal dialysis (PD) (n = 75), and hemodialysis (HD) (n = 51), with the aim of analyzing the impact of the different modes of therapy on serum leptin levels. We used a multivariate approach, taking into consideration the potential effects of other epidemiological, dialysis-related, nutritional, and hormonal factors on serum leptin. Leptin levels were higher in patients treated with PD (median, 36 ng/mL) than in those undergoing CTh (10.8 ng/mL) or HD (5.4 ng/mL) (P < 0.0005). This difference persisted after controlling for gender, body mass index, and fasting insulin levels, suggesting that imbalances in these factors may only partially explain the differences found between the three modes of therapy. Leptin levels showed a significant negative correlation with peritoneal protein losses in PD patients but were poorly associated with factors such as proteinuria, daily peritoneal glucose absorption (PD), renal function, or adequacy of dialysis. Leptin and insulin-like growth factor-I (IGF-I) were significantly correlated in PD patients, but the study design did not allow for establishing a meaning for this correlation. In conclusion, serum leptin levels are increased in PD patients when compared with CTh or HD patients. Differences in gender distribution, fat mass, and insulin levels may partially explain these findings, but other undefined factors also may have a role in producing these results.

Adolescent↗
PubMed1999

Early immunologic and nonimmunologic predictors of arterial hypertension after renal transplantation.

We followed up a cohort of 680 renal transplant recipients receiving cyclosporine (CsA) immunosuppression with the aim of establishing an early-risk profile for early and late hypertension (HT) after renal transplantation (RTx), specifically comparing the predictive role of immunologic and nonimmunologic markers of graft prognosis. HT was defined as the need for antihypertensive drugs. The prevalence of HT was 65% at the time of RTx, increased to a peak of 78% at the end of the first year, and stabilized between 71% and 73% thereafter. Multivariate analysis identified HT at the time of RTx, basal renal disease, and grafting the right kidney as independent predictors of HT 3 months after RTx. The risk profile for HT 12 months after RTx included HT present at RTx, grafting the right kidney, markers of early ischemia-reperfusion injury (delayed graft function, cold and warm ischemia), and transplant from an elderly or female donor. Polytransfusion before RTx was associated with a decreased risk for HT, but retransplantation, increased reactivity against the lymphocyte panel, poor HLA compatibility, and early acute rejection did not portend an increased risk for the complication under study. The CsA schedule (dose, trough levels) correlated poorly with the blood pressure status of the patients, but simultaneous graft function was independently associated with late HT. In conclusion, the early predictive profile for HT after RTx includes, preferentially, nonimmunologic markers of graft prognosis. Hyperfiltration damage may be a significant pathogenic mechanism for this complication of RTx.

Adolescent↗
PubMed1998

The prognostic significance of acute renal failure after renal transplantation in patients treated with cyclosporin.

We studied 733 cadaveric renal transplant patients (747 transplants) under cyclosporin immunosuppression, to: (i) establish the risk profile for acute renal failure (ARF) after renal transplantation in a unit using many sub-optimal donors; (ii) assess the long-term prognostic relevance of ARF; and (iii) explore the synergistic prognostic significance of delayed graft function and acute rejection during the early post-transplant period. Transplanting from a non-heart-beating or elderly donor, protracted cold ischaemia, haemodialysis immediately before transplant surgery, poor HLA matching, and grafting to a hypersensitized recipient without residual renal function, all independently predicted delayed graft function. This delay had no detrimental effect on patient or graft survival, but prolonged ARF was associated with increased mortality from infection. Late markers of graft dysfunction (poor graft function, proteinuria, hypertension) were highly prevalent among grafts affected by ARF, specially in prolonged ARF. Delayed graft function and early acute rejection showed a definite, albeit not strong, additive impact on late graft survival, and also on the prevalence of late markers of graft dysfunction.

Acute Kidney Injury↗
PubMed1996

Survival on chronic peritoneal dialysis: have results improved in the 1990s?

One hundred and seventy patients were treated with home peritoneal dialysis (PD) in our unit between 1986 and 1994. During this time lapse, several technical improvements were included in our practice. Among others there were: Swan neck permanent catheters, Y-systems, and automated home PD (APD). We reviewed our experience, to assess if these improvements had any impact on patient and technique survival, comparing patients who started PD between 1986 and 1989 (group A), with those who started PD between 1990 and 1994 (group B). Both groups had a comparable basal comorbidity, except for a higher proportion of elderly patients in group B (mean age 48 vs 58 years, p < 0.01). The incidence of peritonitis was lower in group B, while there were no differences in the rates of catheter-related infection or hospital admission. Also, there were no significant differences in patients or technique survival. The increasing presence of elderly patients in our PD unit was, apparently, determinant for the evolution of patient survival. On the other side, technical improvements had a marginal impact on technique survival. A good general PD survival in both groups, with few patients changing to hemodialysis (HD), may explain the lack of significant differences. In addition, peritonitis and inadequate PD/ultrafiltration (UF) were replaced by abdominal surgical events and social reasons as the main causes for PD failure in the second phase of the study.

Adult↗
PubMed1996

The economic cost of dialysis: a comparison between peritoneal dialysis and in-center hemodialysis in a Spanish unit.

We have studied the economic cost of dialysis therapy in our area (public setting) during 1994, comparing the cost of different modalities of in-center hemodialysis (HD) and home peritoneal dialysis (PD). Analyzed costs included: personnel, drug expenditure, disposable (dialysis- and non-dialysis-related), laboratory, other services, indirect costs, maintenance and redemption, hospital admissions, transport, and home supplies. The final cost per patient and year (in 1994 US$) was: hemodiafiltration (AN69 filter, bicarbonate buffer) $58,890; HD polymethylmethacrylate filter and bicarbonate buffer $55,076; HD cuprophane and acetate buffer $49,767; CAPD $31,201; and cost of automated PD $42,519. The main expenditure sections were: home supply and hospital admissions for PD patients, and personnel, drug expenditures, disposable dialysis material, indirect costs, hospital admissions, and transport for HD patients. Home peritoneal dialysis therapy has a significantly lower economic cost than any in-center HD modality.

Adult↗
PubMed1996

Delayed graft function after renal transplantation in patients undergoing peritoneal dialysis and hemodialysis.

We have compared the incidence of delayed graft function (DGF) after renal transplantation in our patients undergoing peritoneal dialysis (PD) (group A, n = 92) or hemodialysis (HD) (group B, n = 587), analyzing the prevalence of the main risk factors for DGF in both groups. Both groups were comparable, except for a higher prevalence of diabetes (p < 0.05) and a shorter time on dialysis (p < 0.01) in group A. Immediate graft function occurred in 68.5% of group A and 46.5% of group B, DGF in 22.5% of group A and 39.5% of group B, and there was never any function in 9% of group A and 14% of group B (p < 0.001). When potential risk factors for DGF were compared, no relevant differences could be found. HD was performed more frequently immediately before surgery in group B (p < 0.001), but statistical analysis showed no impact of this measure on the incidence of DGF. In conclusion, in our population, patients on PD present higher rates of immediate graft function after renal transplantation than patients on HD. The explanation for the difference is not clear, but seems to be related to the dialysis modality itself, as the profile of risk factors for DGF is very similar in both populations.

Adult↗
PubMed1996

Treatment of CAPD-related peritonitis with ciprofloxacin: results after seven years.

We present the results of a protocol of empiric monotherapy of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis with ciprofloxacin (CPX), with a special emphasis on the evolution of our results after seven years of continued use of this drug. One hundred and fifteen episodes of bacterial peritonitis were treated with CPX between 1988 and 1992 (group A), and 115 episodes were treated between 1993 and 1995 (group B). The etiologic spectrum of peritonitis was similar in both groups, except for a higher incidence of polymicrobial infections in group B. The clinical success rate decreased from 86.5% in group A to 75% in group B (p < 0.05). This was partly due to the high failure rate of CPX against polymicrobial peritonitis, but the success rate also tended to decrease for gram-positive and, especially, gram-negative bacteria. However, in vitro sensitivity to CPX decreased only for coagulase-negative staphylococci, remaining stable for Staphylococcus aureus and gram-negative bacteria. CPX is still a valid alternative for the treatment of CAPD-related peritonitis in our unit. However, bacterial sensitivity must be closely monitored, especially in the case of coagulase-negative staphylococci. A different therapeutic approach may be indicated if polymicrobial peritonitis is suspected.

Anti-Infective Agents↗
PubMed1994

Complications of permanent catheter implantation for peritoneal dialysis: incidence and risk factors.

We reviewed the incidence and risk factors for complications after insertion of permanent catheters for peritoneal dialysis (PD). We implanted 192 peritoneal catheters in 137 patients over ten years. Fifty-three complications were observed in 50 catheters (27.6%) implanted in 42 patients (30.6%): malposition or omental entrapment (13%), dialysate leak (8.9%), hemoperitoneum (3.6%), peritonitis (1%), surgical wound infection (0.5%), and chylous ascites (0.5%). The only significant risk factors for a complicated insertion were previous abdominal surgery, particularly if it affected the peritoneal membrane, and early use of the catheter after implantation (< 5 days), independent of surgical or closed insertion.

Catheters, Indwelling↗
PubMed1993

Treatment of Staphylococcus aureus nasal carriers in continuous ambulatory peritoneal dialysis with mupirocin: long-term results.

We present the clinical results of a prospective protocol of the treatment of Staphylococcus aureus nasal carriers (SANCs) in our continuous ambulatory peritoneal dialysis unit with mupirocin (Bactroban, SmithKline Beecham Pharmaceuticals, Philadelphia, PA). We monitored the incidence of peritonitis and catheter exit-site infection, the rate of infection-related catheter loss, and the degree of association between SANC state and S aureus infection. The study group included 94 patients with a follow-up of 1,097 patient-months (phase B). The same information was retrospectively collected among 74 continuous ambulatory peritoneal dialysis patients treated during the 24 months preceding the study period (follow-up of 1,043 patient-months) (phase A). S aureus nasal carriage was observed in 47.5% of the patients. Mupirocin was very effective in eradicating S aureus from the nares, but most patients required periodic retreatment. The incidence of S aureus peritonitis decreased from 1 episode/58 patient-months in phase A to 1 episode/548 patient-months in phase B, and the incidence of exit-site infection decreased from one episode/55 patient-months in phase A to 1 episode/137 patient-months in phase B. However, there was a simultaneous increase in the incidence of infections by other gram-positive and -negative bacteria. The rate of catheter loss after peritonitis (P = not significant) or exit-site infection (P < 0.05) tended to decrease from phase A to phase B. Seventy-seven percent of the peritonitis infections and 74% of the exit-site infections by S aureus occurred in SANCs.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intranasal↗
PubMed1993

Treatment of peritonitis in CAPD with ciprofloxacin: long-term experience.

We present the long-term results of a protocol of empirical monotherapy of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis with ciprofloxacin. One hundred and fifteen episodes of peritonitis were studied. The treatment protocol included 5 days of intraperitoneal (IP) administration of the drug, followed by 10 days of oral therapy. A good clinical response was obtained in 83% of the cases, while treatment failure was observed in 4% and relapse in 7%. A decrease in the sensitivity to ciprofloxacin of the peritonitis agents was observed in the study, with Staphylococcus spp. in particular. Three episodes of peritonitis due to bacteria resistant in vitro to ciprofloxacin responded to the treatment protocol. Ciprofloxacin attained good plasma levels both after oral and IP administration. However, dialysate levels were poor after oral administration. The most frequent side effect was gastric intolerance to oral ciprofloxacin. Two patients experienced severe adverse reactions to the drug. Ciprofloxacin may be a good choice for empirical monotherapy of CAPD-related peritonitis. However, the emergence of bacterial resistances must be carefully monitored. The drug should be administered intraperitoneally, at least to induce remission of the infection. Side effects are not frequent, but ciprofloxacin should not be considered an innocuous drug.

Ciprofloxacin↗
PubMed1992

Treatment of Staphylococcus aureus nasal carriers in CAPD with mupirocin.

We have studied the efficacy of topical Mupirocin for elimination of Staphylococcus aureus (Staph. aureus) nasal carriage in CAPD patients. Staph. aureus nasal carriers in our CAPD program were randomized to one of two groups: Group 1, treated with Mupirocin, and Group 2, treated with neomycin sulphate nasal ointment. The prevalence of Staph. aureus nasal colonization was 44% for patients (24/54) and 17% for dialysis partners (5/29). Group 1 included 11 patients and 1 partner, and Group 2, 8 patients and 2 partners. In Group 1, the eradication rate was 100%, and the recolonization rate was 0, 8, 41, 55 and 66% at 1, 2, 3, 6 and 10 months. In Group 2, the eradication rate was 40%, with a recolonization rate of 0.25 and 75% at 1, 2 and 3 months. Re-treatment with mupirocin was successful in 66% of the cases, compared to 20% for neomycin. The MIC90 of mupirocin for Staph. aureus was 0.5 mcg/mL, with an increase to 4 mcg/mL towards the end of the study. During the study period, there was a very low incidence of Staph. aureus peritonitis or catheter-related infections in patients treated with mupirocin. Secondary effects of mupirocin were negligible. Mupirocin is more effective than neomycin sulphate for the elimination of Staph. aureus nasal colonization in patients undergoing CAPD. Periodic re-treatment is frequently necessary, given the significant recolonization rate.

Administration, Topical↗