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F Coronel

Publications and source records attributed to F Coronel.

At least 37 records · Page 2Linked to original sources
PubMed1994

Hemodialysis with acetate, DL-lactate and bicarbonate: a hemodynamic and gasometric study.

Using invasive techniques we have studied various hemodynamic and gasometric parameters in the course of hemodialysis (HD) with different buffers in an animal model. HD sessions of 180 minutes at zero ultrafiltration were carried out on three groups of eight uremic dogs each, under anesthesia and constant mechanical ventilation. The three groups differed only in the buffer used: acetate (Group AC), equal proportions of DL-lactate and acetate (Group AC+LA), and bicarbonate (Group BC). No hemodynamic changes were seen in Group BC. In the AC and AC+LA groups we observed on minute 1 a decrease of the mean blood pressure (MBP) and of the systemic vascular resistances (SVR). These parameters returned to baseline values within the first 30 minutes in Group AC+LA. In Group AC the SVR also returned to baseline values after the minute 30, but the MBP remained below baseline throughout the study period, together with cardiac index and left ventricular stroke work index decreases. Only in Group AC did we see a flattening of the ventricular function curves. Only in this Group was there a decrease of the arterial oxygen pressure (PaO2) with an associated increase of the alveolo-arterial and arterio-venous O2 differences. The O2 consumption was not modified in any of the groups. Acetate as a single buffer induces hemodynamic instability through peripheral vasodilation and reduction of myocardial contractility. The myocardial depression induced by acetate, in its turn, causes a reduction in PaO2. The mixed acetate+lactate buffer is hemodynamically better tolerated than acetate as single buffer, as it induces only vasodilation.

Acetates↗
PubMed1993

Iron deficiency anemia after successful renal transplantation.

In patients with chronic renal failure, renal transplantation improves anemia and the production of erythropoietin. In patients undergoing hemodialysis the administration of recombinant human erythropoietin improves anemia with a decrease in bodily iron stores. Therefore, one would expect a similar decrease after kidney transplantation. We followed the ferric parameters to determine the incidence of iron deficiency anemia in 24 consecutive renal transplant patients for an interval long enough to achieve steady state values of hemoglobin (5.1 +/- 0.8 months). Hematological parameters and serum levels of iron, ferritin and erythropoietin were measured. The patients were divided into 2 groups according to the decrease in serum ferritin: group 1--16 with a decrease in respect to basal values (114 +/- 56 ng./ml.) and group 2--those without modifications (720 +/- 320 ng./ml.). Except for the similar values, group 1 showed greater improvement in anemia (red blood cells 4.3 x 10(6) +/- 1.1 x 10(6) versus 3.7 x 10(6) +/- 1.5 x 10(6)/ml., p < 0.01) and hematocrit index (38.5 +/- 5.2 versus 33.0 +/- 5.1%, p < 0.05). Four patients had microcythemia (mean corpuscular volume 76.6 +/- 1.4 fluid) with lower hemoglobin values than the other patients in group 1 (10.77 +/- 0.42 versus 12.79 +/- 0.42 gm./dl., p < 0.05). Among the 16 patients in group 1, 7 of 8 whose basal serum ferritin was less than 150 ng./ml. achieved ferritin levels of less than 30 ng./ml. In conclusion, our data support that renal transplantation produces a rapid decrease in iron stores and in some cases induces iron deficiency anemia. This fact should be evaluated and treated properly.

Adult↗
PubMed1992

Adequacy of peritoneal dialysis: does kt/v have the same predictive value as in HD? A multicenter study.

Urea kinetics and the use of KT/V has become a useful tool for assessing adequacy of small solute removal in HD. Clinical data supporting the benefit of urea kinetic analysis in CAPD patients had been lacking. Using the standards of KT/V for hemodialysis, many CAPD patients would be underdialyzed but, most studies show no significant difference in morbidity or mortality between CAPD and HD patients. We studied retrospectively, 102 patients (48 M, 54 F), aged 54.6 +/- 14.8 (range 14-82), on CAPD 24.4 +/- 23.9 months (0-120) from 6 hospitals. Clinical and biochemical parameters, co-morbidity, mortality, and hospital admission rate were registered. During the follow-up (1 year), a significant decrease of residual renal function (Kr) from 1.74 +/- 1.86 to 1.31 +/- 1.67 (p < 0.01) was noticed. The KT/V also decreased from 2.00 +/- 0.47 to 1.89 +/- 0.36 (p < 0.01) without change in BUN or plasma creatinine levels. The normalized protein catabolic rate (NPCR) decreased from 0.98 +/- 0.28 to 0.93 +/- 0.30 (p < 0.05) and serum albumin from 3.7 +/- 0.5 to 3.5 +/- 0.6 (p < 0.001). There was a positive correlation between NPCR and KT/V (r = 0.44, p < 0.05) and between NPCR with serum BUN (r = 0.27, p < 0.05). There was no correlation between KT/V and NPCR neither with hospitalization rate nor clinical symptoms index. The latter, however, showed a positive correlation with the co-morbidity index.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Treatment of hyperlipemia in diabetic patients on dialysis with a physiological substance.

Hyperlipemia is a very frequent complication of the diabetic patient on dialysis. There is difficulty of treatment with the diet, because the dietary restriction already imposed on these patients and the secondary effects and toxicity of the available drugs in uremics aggravate the problem. We have treated 22 diabetic patients on dialysis (8 on hemodialysis and 14 on continuous ambulatory peritoneal dialysis) suffering from hyperlipemia with pantethine, a physiological substance and coenzyme A precursor in the Krebs cycle. With the administration of an oral dose of 900 mg/day we obtained a reduction of total cholesterol (275 +/- 72 vs. 231 +/- 54 mg/dl; p less than 0.001), very-low-density lipoprotein (VLDL)-cholesterol (66 +/- 36 vs. 46 +/- 18 mg/dl; p less than 0.01) and triglycerides (332 +/- 182 vs. 227 +/- 90 mg/dl; p less than 0.01) at 2 months. High-density lipoprotein (HDL)-cholesterol did not change, but the total cholesterol/HDL-cholesterol ratio decreased significantly (p less than 0.05). Total cholesterol, VLDL and triglycerides showed a progressive and significant reduction at 4 and 6 months. No changes were observed in serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, uric acid, blood glucose and glycosylated hemoglobin. Gastric discomfort in 2 patients and pruritus in another one were the secondary effects related. Pantethine was shown to be a very effective hypolipemic agent in diabetic patients on dialysis with a great tolerance.

Cholesterol↗
PubMed1991

Fructosamine levels in CAPD: its value as glycemic index.

We have studied fructosamine (measured by colorimetric methods) and glycosylated hemoglobin (HbA1c) using a high pressure liquid chromatography (HPLC) in 20 uremic patients managed conservatively (8 diabetics and 12 non-diabetics) and 20 patients treated with continuous ambulatory peritoneal dialysis (CAPD) including 12 diabetics and 8 non-diabetics. Twenty healthy subjects were used as control group. We have correlated the mean blood glucose (MBG) of the preceding days to fructosamine and HbA1c measurements. No differences were detected in mean fructosamine and HbA1c levels in non-diabetics patients in the CAPD or conservatively treated groups compared to controls. In diabetic patients undergoing conservative treatment or CAPD, mean fructosamine and HbA1c values were elevated when compared with control group. Both glycemic indicators were increased in most of the diabetic patients, was higher values in those patients with higher MBG. There was a good correlation in CAPD diabetic patients between fructosamine and HbA1c with MBG of the 21 previous days (r = 0.84, p less than 0.01 and r = 0.74, p less than 0.01 respectively). There was also correlation between fructosamine and HbA1c in CAPD diabetic patients (r = 0.78, p less than 0.01). We conclude that fructosamine does not seem to be influenced by uremia or by CAPD. Fructosamine and also glycosylated hemoglobin, when c-fraction is measured and HPLC method is used, can be utilized as glycemic indexes in CAPD diabetic patients.

Adult↗
PubMed1991

Peritoneal clearances, protein losses and ultrafiltration in diabetic patients after four years on CAPD.

Peritoneal clearances of urea (C(urea)) and creatinine (Ccr), peritoneal protein losses (PL) and ultrafiltration (UF) were retrospectively evaluated in 12 diabetic patients on continuous ambulatory peritoneal dialysis (CAPD) during a four year study. The average of three determinations each year was calculated. There were not significant differences in C(urea) (ml/24 hours), Ccr (ml/24 hours), PL (g/24 hours) and UF (ml/24 hours) between the four years and basal values or in the year to year studies. Seven patients did not modify their CAPD schedule during the four years study and we did not find any statistical differences in this group in the parameters studied. There was an average incidence of peritonitis of 4.7 episodes, higher in the 2 first years (p less than 0.05). The peritonitis incidence did not affect any of the functional parameters evaluated. The results of our study suggest that C(urea), Ccr, PL and UF in diabetic patients are not affected by long-term CAPD or by the peritonitis incidence.

Creatinine↗
PubMed1990

Partial substitution of sodium lactate for sodium acetate in the bath fluid for hemodialysis.

To the authors knowledge, lactate (LA) has never been used in hemodialysis concentrates. A new concentrate has been designed in which a low acetate (AC) concentration is complemented with LA up to standard quantities of buffer with the aim of minimizing the side effects of AC. In 14 classically AC-intolerant hemodialysis patients (low body surface area of 1.47 +/- 0.15 m2, decrease of serum bicarbonate level during hemodialysis by 2 mmol/L or more, and postdialysis hyperacetatemia of greater than 7.0 mmol/L) a concentrate with LA was used (Na, 138; K, 1.5; Ca, 1.75; Mg, 0.75; Cl, 109.5; AC, 17.5; and D,L-lactate, 17.5 mmol/L) and compared with the same bath with only AC as a buffer (35 mmol/L). Patients were blindly and randomly assigned to either the AC or the LA bath during six hemodialyses. Blood gases, AC, and L-LA levels were measured before and after dialysis. The number of symptomatic hypotension episodes and other symptoms such as vomiting, headache, or cramps were recorded in each dialysis. The postdialysis pH showed the same increase with both concentrates. The AC dialysis caused a significant decrease in PCO2 (26.05 +/- 2.48 versus 34.37 +/- 2.24 mm Hg; p less than 0.001) and bicarbonate level (15.84 +/- 2.12 versus 19.82 +/- 1.45 mmol/L; p less than 0.001). Dialysis with LA showed a smaller decrease in PCO2 (31.60 +/- 2.00 versus 35.45 +/- 2.25 mm Hg; p less than 0.01), and the bicarbonate level remained stable (19.43 +/- 1.85 versus 20.02 +/- 1.91 mmol/L; NS). Final acetatemia was lower in LA dialysis (3.12 +/- 1.6 versus 9.73 +/- 1.6 mmol/L; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗
PubMed1990

Diabetic patients on CAPD need less aluminum hydroxide as a phosphate binder than non-diabetics.

A retrospective study was done in 86 patients on dialysis in order to evaluate the doses of aluminum hydroxide (OH3 Al) received to achieve a better serum phosphate control. Thirty-seven patients were treated with continuous ambulatory peritoneal dialysis (CAPD) divided in 22 diabetics and 15 non-diabetics. Forty-nine patients were treated with hemodialysis (HD), 12 diabetics and 37 non-diabetics. The doses of 1-25 Dihidroxycholecalciferol (1-25 DOH-D3) were similar in all patients. The serum phosphate levels were similar in CAPD and HD patients with smaller doses of OH3 AL in CAPD patients (p less than 0.001). Diabetics on either technique need less OH3 AL in CAPD (CAPD p less than 0.01; HD p less than 0.05) to achieve the same or better control of serum phosphorus than non-diabetics. The overload of glucose on CAPD and the maintained hyperglycemia on diabetes mellitus would shift phosphorus into the cell and could explain these results. Finally, the less needs of aluminum hydroxide on diabetic patients could contribute to their protection against aluminum deposition and its effects.

Aluminum Hydroxide↗
PubMed1989

[Morbidity and mortality of diabetic patients on dialysis in a 10-year program: value of combined treatment].

Morbidity and mortality derived from the employed techniques after ten year experience in treating patients afflicted with end-stage diabetic nephropathy by means of dialysis are evaluated. Hemodialysis (HD) was applied to 24 patients, continuous ambulatory peritoneal dialysis (OCPD) was employed in 33 patients and intermittent peritoneal dialysis (IPD) in nine patients. Cumulated experience with each technique was 529, 644, and 107 months, respectively. Ten patients were treated with a combination of two or three techniques. Hospitalization rate in patients receiving CAPD was 32 days/year, peritonitis was the most frequent condition leading to admittance (54.8%), followed by cardiovascular alterations (14.4%) and gastrointestinal complications (10.5%). On hemodialyzed patients, hospitalization rate was 24.7 days/year and complications derived from vascular access were the most frequent admittance cause (34%), followed by cardiovascular complications (20.4%) and hypertension (11.3%). Peritonitis (45%), vascular complications (15%) and metabolic impairment (15%) were the most frequent causes of admittance in IPD patients; hospitalization rate was 88 days/year. Actuarial survival in patients on CAPD was 92% during first year, 79% during second, and 64% during third and fourth years. On hemodialyzed patients, 90% of patients survived during first year and 80%, 48%, and 36% during second, third, and fourth years, respectively. On IPD, survival during first year was 63% and 12% at 18 months. By combinating two or the three methods, survival was 100% at 12 months and 88% at 4 years. Although CAPD as isolated technique may offer to diabetic patients a longer survival and HD a lower hospitalization rate, combined treatment (HD-CAPD-IPD) may provide a survival matchable to that achieved in renal transplantation.

Adult↗
PubMed1989

Analysis of factors in the prognosis of diabetics on continuous ambulatory peritoneal dialysis (CAPD): long-term experience.

After five years of treating diabetics by continuous ambulatory peritoneal dialysis (CAPD), we analyzed the factors involved in prognosis. Forty-one patients were included in the study, with a cumulative experience of 784 months. Good control of blood glucose was obtained with intraperitoneal (i.p.) insulin and the blood pressure was controlled in 87% of patients without medication, which probably favored the stabilization of visual acuity in 60% of 15 patients evaluated after two years. The follow-up of patients was longer in those who began CAPD with a higher residual creatinine clearance. In spite of large number of patients who were blind or had very poor vision, 83% of all patients were self-sufficient and well-trained for CAPD, and 39% were able to work full time. The incidence of peritonitis declined to 1 episode per 17.5 patient months associated with the introduction of new preventive measures. Patients over 50 years old had the highest mortality rate and myocardial infarction was the main cause of death. Patient survival at 6, 12, 24, 36, and 42 months was 100, 90, 80, 62, and 62%, respectively. Age and cardiac problems are important factors in survival. Self-sufficiency, rehabilitation, and low incidence of peritonitis are also important factors in the life quality of diabetic patients on CAPD.

Diabetic Angiopathies↗
PubMed1989

[Complications in diabetic patients on dialysis: experiences in 10 years of treatment using 3 technics].

In treated diabetic patients with terminal renal failure we have examined the complications arising from the dialysis technique used. 55 patients were followed up for 1.279 months. Out of the latter, 24 were on hemodialysis (HD) 33 on continuous ambulatory peritoneal dialysis (CAPD) and 9 on intermittent peritoneal dialysis (IPD). Intraperitoneal insulin in patients on CAPD best controlled glycemia. Antihypertensive therapy was not necessary in 86%, 66%, and 46% of the patients on CAPD, IPD and HD respectively (CAPD vs HD, p less than 0.001). Acute myocardial infarction was more common in patients on HD (33%) (p less than 0.05). 22% of the patients on IPD had limb amputation (IPD vs CAPD-HD, p less than 0.05). The type of dialysis method used does not seem to influence the course of the retinopathy. The neuropathy behaved in a similar manner in those on CAPD and on HD when followed up for two years. Vascular complications were frequent in those on HD with one thrombotic event every 9.7 months/patient and a new vascular access every 7.4 months/patient. Peritonitis was the main complication of CAPD and IPD which was found more frequent in the former and longer hospitalization in the latter. The election of the dialysis technique in diabetic patients can directly influence the glycemia levels and blood pressure reading, as well as heart complications and those due to the method used. However they seem to influence less the neuropathy, retinopathy and peripheral vasculopathy.

Adult↗
PubMedDate not supplied

A 2 year evaluation of diabetic patients on continuous ambulatory peritoneal dialysis.

Nineteen diabetic patients with end-stage renal disease on CAPD were evaluated over a 2 year period. All but one patient was insulin-dependent, with a mean age of 47.7 years. Average time on CAPD was 16.1 months (range, 2-28 months). Thirteen patients were followed for more than 12 months, and nine for more than 18 months. The mean training period was 22.9 days. Good blood glucose control was obtained with intraperitoneal (IP) insulin in all of the patients. Mean blood glucose levels of 125 +/- 23.08 mg/dl were achieved with 103 +/- 38.5 U/day of regular IP insulin. Glycosalated hemoglobin decreased from a mean of 12.7 +/- 2.35% before CAPD to 10.08 +/- 0.97% during CAPD. Peritoneal creatinine clearance remained stable during the study period, with a concommitant decrease (P less than 0.001) in the mean residual renal creatinine clearance. The incidence of peritonitis was one episode per 7.8 patient-months. Average length of hospitalization was 33.24 days/year. Visual acuity remained stable after 1 year in 73% of the 26 eyes evaluated. No amputations were required in more than 2 years of follow-up. Actuarial survival was 100% at 1 year and 86% at 2 years, and the technique survival of CAPD was 91 and 79%, respectively. These results demonstrate that CAPD is a good dialysis procedure for treating diabetic patients with chronic renal failure, and it offers the advantage of controlling glycemia better than other dialysis methods.

Adult↗