Revista de nefrología y terapéutica

Elderly hemodialysis patients particularly suffer from protein-energy wasting syndrome due to age-related physiological changes. We carried out an observational study from 1 to 30 April 2016 involving 31 elderly hemodialysis patients in the center of Cahors University Hospital. We intended to check how close the 3 methods of nutritional evaluation were, namely ingesta, albumin/prealbumin association and Subjective Global Assessment. We trialed the nutritional status of each patient using the above methods.

The mean age was 77.7 ± 7.07 years with M/F ratio of 0.63. Exposure to dialysis was 40.61 ± 67.88 months on average. The mean BMI was 26.67 ± 9.17 kg/m2. The average daily calorie and protein intake was 1297.61 ± 321.73 Kcal and 52.87 ± 9.89 g, respectively. The average branchial perimeter was 27.53 ± 2.47 cm with a mean triceps skinfold of 9 ± 0.7. The daily protein intake assessed by the nPCR was 0.95 ± 0.21 g/kg/day. The mean albumin and pre-albumin levels were 37.32 ± 1.41 g/l and 283.22 ± 35.35 mg/l. The average Kt/V was 1.98 ± 0.35. According to the SGA, 26 (83.87%) were in good nutritional status (subgroup 1), 3 (9.67%) were suffering from mild undernutrition (subgroup 2) and 2 (6.46%) had acute undernutrition (subgroup 3). Relying on albumin and prealbumin levels, 18 (58.06%) were in good nutritional status, 6 (19.36%) had mild undernutrition and 7 (22.58%) acute undernutrition. According to the ingesta, 2 (6.46%) patients were in subgroup 1, 8 (25.81%) patients in subgroup 2 and 21 (67.74%) in subgroup 3. No agreement was found between the 3 evaluators of nutritional status (kappa to assess SGA and albumin-pre-albumin association at -0.075 [95% confidence interval: -0.175 to 0.024]; kappa as a measurement for SGA and ingesta at 0.073 [95% range: -0.007 to 0.153], kappa for albumin-prealbumin combination and ingesta at 0.034 [95% confidence interval: -0.058 to 0.126)].

Disjunction between the three nutritional evaluators used in our study, in addition to inherent bias in the low number of staff, provides information on the nutritional problems of elderly hemodialysis patients, especially underestimation of nutritional surveys in relation to actual energy intake, nutritional impact of the physiological and socio-economic changes that accompany aging and the lack of nutritional methods and standards specific to this category of population.

Objetivo: La diabetes de nueva aparición después del trasplante (NODAT) es una de las complicaciones médicas después del trasplante de riñón que afecta negativamente al riñón del aloinjerto y los resultados del paciente. El objetivo de este estudio fue conocer la incidencia del desarrollo de NODAT, investigar los factores de riesgo y sus efectos sobre el riñón del aloinjerto en nuestro centro.
Material y métodos: Este es un estudio observacional retrospectivo de los pacientes que se sometieron al trasplante de riñón en el Narayana Medical College & Hospital desde junio de 2009 hasta mayo de 2016. Los pacientes se dividieron en grupos NODAT y no NODAT.
Resultados: 21 de 84 pacientes (25%) desarrollaron NODAT durante el período de seguimiento del 1er año después del trasplante. Encontramos edad >30 años (OR: 3,8; P=0,012), antecedentes familiares de diabetes (OR: 8,6; P=0,0004), glucemia en ayunas alterada (OR: 7,27; P=0,0003), hiperglucemia postoperatoria (OR: 2,83; P=0,04), triglicéridos en ayunas >150 mg/dl (OR: 8,0 P=0,0001) y niveles de VLDL (42,52 ± 30,81 mg/dl vs. 24,24 ± 5,51 mg/dl; P= 0,01) como factores de riesgo para NODAT. Los valores medios de creatinina sérica fueron 1,23 ± 0,25 mg/dl frente a 1,16 ± 0,35 mg/dl (P = 0,42) y 1,61 ± 0,53 mg/dl frente a 1,44 ± 0,54 mg/dl (P = 0,24) al final del primer mes y del primer año postrasplante en los grupos NODAT y no NODAT respectivamente.
Conclusión: La incidencia acumulada de NODAT fue del 25% al ??final del primer año postrasplante. La edad avanzada, los antecedentes familiares de diabetes, la dislipidemia, la glucemia en ayunas alterada antes del trasplante y la hiperglucemia postoperatoria se consideraron factores de riesgo, algunos de los cuales pueden ser bastante modificables.

Objective: We undertook this study to analyze the T CD4 subset of non-HIV CKD patients and to investigate factors that may influence their rate.

Materials and methods: It was a cross-sectional, three-month study, on the determination of T CD4, count by Flow Cytometry (FACS Calibur), in patients aged 18 to 65 years, chronic kidney disease according to KDOQI and non-HIV.

Results: Sixty-three cases were collected with an average age of 41 years and sex ratio of 1.79. The median BMI was 22.9 kg/m² and 69.9% had normal weight. 36 of patients (69.2%) were at stage 5 of chronic kidney disease. CD4 rate was low in 23 patients (36.5%), normal in 37 patients (58.7%) and high in 3 patients (4.8). There was a significant correlation between the decrease in absolute CD4 rate and the grade of chronic kidney failure (CKD) (p=0.02). In linear regression, a statistically significant correlation was observed between changes in absolute CD4 values and white blood cell level (p=0.000003), total lymphocyte rate (p=0,0006) and urea rate (p=0.04); on the other hand between changes in the absolute values of CD3 and the levels of white blood cells (p=0.000001) and lymphocytes rate (p=0.000002).

Conclusion: The decrease in GFR is accompanied by a decrease in CD4 rate, which increases the risk of infections. This situation could contribute significantly to the morbidity and mortality of chronic kidney disease patients.

Severe acute liver failure in adults is a condition that may lead to several complications such as cerebral edema and acute kidney injury requiring liver transplant. Few studies analyze the benefit of dialysis therapies for decreasing bilirubin and ammonia levels to achieve metabolic compensation. In Ecuador there are no case reports of treatment with combined hemoperfusion and online hemodiafiltration. We report the case of a patient who was diagnosed with fulminant hepatic failure due to acute alcoholic hepatitis and concomitant acute kidney injury. We include the clinical course after adding two sessions of combined hemoperfusion and online hemodiafiltration to the conventional treatment.