Efeito do ajuste do fluxo dialisante (Qd) sobre a eficácia em hemodiálise realizada em pacientes com baixo peso

Las guías KDOQI del año 2006 utilizan como estándar de adecuación para la diálisis el parámetroKt/V, donde V es el volumen de distribución de urea. Los pacientes con bajo peso tienen menorcantidad total de agua corporal total (menor V), de modo que es posible reducir la cantidad de Qdsin alterar la eficacia de la diálisis. Objetivo: evaluar el efecto de la reducción del Qd sobre la adecuaciónde la diálisis en pacientes con pesos menores o iguales a 60 kg sometidos a hemodiálisis.Metodología: estudio observacional con alcance comparativo realizado en la unidad de diálisis deuna clínica especializada de Bogotá. Se evaluaron dos valores de Qd (400 ml/min y 500 ml/min)dentro del proceso de diálisis de individuos con peso menor o igual a 60 kg. Se hizo un seguimientode tres meses para cada forma de diálisis y al final de cada mes se midieron los niveles de Kt/V,hemoglobina y fósforo. Resultados: fueron incluidos 61 pacientes, 60,7% de sexo femenino. Laedad media fue de 55,9 años (DE 14,8) para las mujeres y 60,1 años (DE 13,9) para los hombres.No se observaron diferencias estadísticamente significativas entre los niveles medios de las variablesevaluadas, en los momentos de seguimiento ni al final del estudio. Conclusiones: es posibletener una adecuada terapia de diálisis utilizando un valor menor al establecido por los estándarestradicionales cuando se tienen pacientes con bajo peso, siempre y cuando se mantengan los demásparámetros de suplencia renal.KDOQI guidelines in 2006 using standard dialysis adequacy Kt/V, where V is volume of distributionof urea, underweight patients have lower total body water, lower V, which couldreduce the requirement without affecting Qd the efficiency of dialysis. Objective: to evaluatethe effect on the adequacy of dialysis Qd reduction occurs in patients weighing less than orequal to 60 kg who are on hemodialysis. Methodology: patients with chronic kidney diseaseon hemodialysis regularly with weight less than or equal to 60 kg of a renal clinic to evaluatetwo periods I and II, were continued therapy parameters with decrease of Qd for the secondperiod. The variables were collected directly by the researchers of the history. The values thusobtained would be compared using t test or paired variables, and statistical significance of thetest below 0,05. Results: we included 61 patients, 60.7% female, mean age 57,3 years (SD 14,8).Average age of men 60.1 (SD 13,9) and women was 55,9 (SD 15,4). There were no statisticallysignificant differences for the variables Kt/V, Hemoglobin and there was a significant reductionin the phosphorus levels. Conclusions: this study demonstrates that adequate therapy is achievedwith less than Qd traditional standards, with 400 ml/min in patients with low weight as long asyou keep the other parameters of renal substitution.As guias KDOQI do ano 2006 utilizam como padrão de adequação da diálise o Kt/V, onde V é ovolume de distribuição da ureia. Pacientes com baixo peso têm menor quantidade total de águano corpo total, (menor V), de modo que seria possível reduzir a quantidade de Qd sem afetara eficiência da diálise. Objetivo: avaliar o efeito que tem a redução do Qd sobre a adequação dadiálise em pacientes com hemodiálise que têm peso menor ou igual a 60 kg. Metodologia: estudodescritivo realizado na unidade de diálise de uma clínica especializada de Bogotá. Foram avaliadosdois valores de Qd (400 ml/min e 500 ml/min) dentro do processo de diálise realizado em indivíduoscom peso menor ou igual a 60 Kg. Realizou-se um seguimento de três meses para cadauma das formas de diálise aplicada e ao final de cada mês realizaram-se medições dos níveis deKt/V, hemoglobina e fósforo. Resultados: o estudo observacional incluiu 61 pacientes, 60,7% dogênero feminino. A idade média foi de 55,9 anos (DE 14,8) para as mulheres e 60,1 anos (DE 13,9)para os homens. Não foram observadas diferenças estatisticamente significantes entre os níveismédios das variáveis nas medições de seguimento nem ao final do estudo. Conclusões: conclui-seque é possível obter uma terapia adequada de diálise com um valor de Qd inferior ao estabelecidosob os padrões tradicionais em pacientes como baixo peso, sempre e quando sejam mantidos osdemais parâmetros de suplência renal

Efecto de ajuste del flujo dializante (Qd) sobre la eficacia en hemodialisis a pacientes de bajo peso

Introducción: Las guías KDOQI del 2006 utilizan patrón de adecuación de diálisis el Kt/V, donde V es volumen de distribución de la úrea, pacientes de bajo peso tienen menor agua corporal total, menor V, que podrían reducir el requerimiento de Qd sin afectar la eficiencia de la diálisis. Objetivo: Evaluar el efecto sobre la adecuación de hemodiálisis que produce la reducción del Qd en pacientes con peso menor o igual a 60 kg . Metodología: Se incluyeron pacientes con Enfermedad Renal crónica en hemodiálisis de forma regular con peso menor o igual a 60 Kg de la unidad renal, para evaluar dos períodos I y II, se continuaron los parámetros de la terapia, con descenso del Qd para el segundo período . Las variables fueron recolectadas de forma directa por los investigadores de la historia clínica . Los valores así obtenidos serían comparados mediante prueba t para variables relacionadas o pareadas, y significancia estadística de la prueba inferior a 0,05. Resultados: Se incluyeron 61 pacientes, el 60.7% sexo femenino, promedio de edad 57,3 años (DE 14,8). Edad promedio de los hombres 60,1 (DE 13,9) y de las mujeres fue de 55,9 (DE 15,4). No se encontraron diferencias estadísticamente significativas para las variables Kt/V y Hb, con descenso significativo del P. (p 0.015) Conclusiones: Este estudio demuestra que se logra una adecuada terapia con Qd inferiores a los estándares tradicionales, con 400ml /min en pacientes de bajo peso, siempre y cuando se mantengan los demás parámetros de suplencia renal.Introduction: KDOQI guidelines in 2006 using standard dialysis adequacy Kt / V, where V is volume of distribution of urea, underweight patients have lower total body water, lower V, which could reduce the requirement without affecting Qd the efficiency of dialysis. Objective: To evaluate the effect on the adequacy of dialysis Qd reduction occurs in patients weighing less than or equal to 60 kg who are on hemodialysis. Methodology: Patients with chronic kidney disease on hemodialysis regularly with weight less than or equal to 60 kg of a renal clinic to evaluate two periods I and II, were continued therapy parameters with decrease of Qd for the second period. The variables were collected directly by the researchers of the history. The values thus obtained would be compared using t test or paired variables, and statistical significance of the test below 0. 05. Results: We included 61 patients, 60. 7% female, mean age 57. 3 years (SD 14. 8). Average age of men 60. 1 (SD 13. 9) and women was 55. 9 (SD 15. 4). There were no statistically significant differences for the variables Kt / V , Hemoglobin and there was a significant reduction in the phosphorus levels. Conclusions: This study demonstrates that adequate therapy is achieved with less than Qd traditional standards, with 400 ml / min in patients with low weight as long as you keep the other parameters of renal substitution

Efecto de ajuste del flujo dializante (Qd) sobre la eficacia en hemodialisis a pacientes de bajo peso

Introducción: Las guías KDOQI del 2006 utilizan patrón de adecuación de diálisis el Kt/V, donde V es volumen de distribución de la úrea, pacientes de bajo peso tienen menor agua corporal total, menor V, que podrían reducir el requerimiento de Qd sin afectar la eficiencia de la diálisis. Objetivo: Evaluar el efecto sobre la adecuación de hemodiálisis que produce la reducción del Qd en pacientes con peso menor o igual a 60 kg . Metodología: Se incluyeron pacientes con Enfermedad Renal crónica en hemodiálisis de forma regular con peso menor o igual a 60 Kg de la unidad renal, para evaluar dos períodos I y II, se continuaron los parámetros de la terapia, con descenso del Qd para el segundo período . Las variables fueron recolectadas de forma directa por los investigadores de la historia clínica . Los valores así obtenidos serían comparados mediante prueba t para variables relacionadas o pareadas, y significancia estadística de la prueba inferior a 0,05. Resultados: Se incluyeron 61 pacientes, el 60.7% sexo femenino, promedio de edad 57,3 años (DE 14,8). Edad promedio de los hombres 60,1 (DE 13,9) y de las mujeres fue de 55,9 (DE 15,4). No se encontraron diferencias estadísticamente significativas para las variables Kt/V y Hb, con descenso significativo del P. (p 0.015) Conclusiones: Este estudio demuestra que se logra una adecuada terapia con Qd inferiores a los estándares tradicionales, con 400ml /min en pacientes de bajo peso, siempre y cuando se mantengan los demás parámetros de suplencia renal.Introduction: KDOQI guidelines in 2006 using standard dialysis adequacy Kt / V, where V is volume of distribution of urea, underweight patients have lower total body water, lower V, which could reduce the requirement without affecting Qd the efficiency of dialysis. Objective: To evaluate the effect on the adequacy of dialysis Qd reduction occurs in patients weighing less than or equal to 60 kg who are on hemodialysis. Methodology: Patients with chronic kidney disease on hemodialysis regularly with weight less than or equal to 60 kg of a renal clinic to evaluate two periods I and II, were continued therapy parameters with decrease of Qd for the second period. The variables were collected directly by the researchers of the history. The values thus obtained would be compared using t test or paired variables, and statistical significance of the test below 0. 05. Results: We included 61 patients, 60. 7% female, mean age 57. 3 years (SD 14. 8). Average age of men 60. 1 (SD 13. 9) and women was 55. 9 (SD 15. 4). There were no statistically significant differences for the variables Kt / V , Hemoglobin and there was a significant reduction in the phosphorus levels. Conclusions: This study demonstrates that adequate therapy is achieved with less than Qd traditional standards, with 400 ml / min in patients with low weight as long as you keep the other parameters of renal substitution

Efeito do ajuste do fluxo dialisante (Qd) sobre a eficácia em hemodiálise realizada em pacientes com baixo peso

Las guías KDOQI del año 2006 utilizan como estándar de adecuación para la diálisis el parámetroKt/V, donde V es el volumen de distribución de urea. Los pacientes con bajo peso tienen menorcantidad total de agua corporal total (menor V), de modo que es posible reducir la cantidad de Qdsin alterar la eficacia de la diálisis. Objetivo: evaluar el efecto de la reducción del Qd sobre la adecuaciónde la diálisis en pacientes con pesos menores o iguales a 60 kg sometidos a hemodiálisis.Metodología: estudio observacional con alcance comparativo realizado en la unidad de diálisis deuna clínica especializada de Bogotá. Se evaluaron dos valores de Qd (400 ml/min y 500 ml/min)dentro del proceso de diálisis de individuos con peso menor o igual a 60 kg. Se hizo un seguimientode tres meses para cada forma de diálisis y al final de cada mes se midieron los niveles de Kt/V,hemoglobina y fósforo. Resultados: fueron incluidos 61 pacientes, 60,7% de sexo femenino. Laedad media fue de 55,9 años (DE 14,8) para las mujeres y 60,1 años (DE 13,9) para los hombres.No se observaron diferencias estadísticamente significativas entre los niveles medios de las variablesevaluadas, en los momentos de seguimiento ni al final del estudio. Conclusiones: es posibletener una adecuada terapia de diálisis utilizando un valor menor al establecido por los estándarestradicionales cuando se tienen pacientes con bajo peso, siempre y cuando se mantengan los demásparámetros de suplencia renal.As guias KDOQI do ano 2006 utilizam como padrão de adequação da diálise o Kt/V, onde V é ovolume de distribuição da ureia. Pacientes com baixo peso têm menor quantidade total de águano corpo total, (menor V), de modo que seria possível reduzir a quantidade de Qd sem afetara eficiência da diálise. Objetivo: avaliar o efeito que tem a redução do Qd sobre a adequação dadiálise em pacientes com hemodiálise que têm peso menor ou igual a 60 kg. Metodologia: estudodescritivo realizado na unidade de diálise de uma clínica especializada de Bogotá. Foram avaliadosdois valores de Qd (400 ml/min e 500 ml/min) dentro do processo de diálise realizado em indivíduoscom peso menor ou igual a 60 Kg. Realizou-se um seguimento de três meses para cadauma das formas de diálise aplicada e ao final de cada mês realizaram-se medições dos níveis deKt/V, hemoglobina e fósforo. Resultados: o estudo observacional incluiu 61 pacientes, 60,7% dogênero feminino. A idade média foi de 55,9 anos (DE 14,8) para as mulheres e 60,1 anos (DE 13,9)para os homens. Não foram observadas diferenças estatisticamente significantes entre os níveismédios das variáveis nas medições de seguimento nem ao final do estudo. Conclusões: conclui-seque é possível obter uma terapia adequada de diálise com um valor de Qd inferior ao estabelecidosob os padrões tradicionais em pacientes como baixo peso, sempre e quando sejam mantidos osdemais parâmetros de suplência renal.KDOQI guidelines in 2006 using standard dialysis adequacy Kt/V, where V is volume of distributionof urea, underweight patients have lower total body water, lower V, which couldreduce the requirement without affecting Qd the efficiency of dialysis. Objective: to evaluatethe effect on the adequacy of dialysis Qd reduction occurs in patients weighing less than orequal to 60 kg who are on hemodialysis. Methodology: patients with chronic kidney diseaseon hemodialysis regularly with weight less than or equal to 60 kg of a renal clinic to evaluatetwo periods I and II, were continued therapy parameters with decrease of Qd for the secondperiod. The variables were collected directly by the researchers of the history. The values thusobtained would be compared using t test or paired variables, and statistical significance of thetest below 0,05. Results: we included 61 patients, 60.7% female, mean age 57,3 years (SD 14,8).Average age of men 60.1 (SD 13,9) and women was 55,9 (SD 15,4). There were no statisticallysignificant differences for the variables Kt/V, Hemoglobin and there was a significant reductionin the phosphorus levels. Conclusions: this study demonstrates that adequate therapy is achievedwith less than Qd traditional standards, with 400 ml/min in patients with low weight as long asyou keep the other parameters of renal substitution

Analysis of Plasminogen Genetic Variants in Multiple Sclerosis Patients

Multiple sclerosis (MS) is a prevalent neurological disease of complex etiology. Here we describe the characterization of a multi-incident MS family which nominated a rare missense variant (p.G420D) in plasminogen (PLG) as a putative genetic risk factor for MS. Genotyping of PLG p.G420D (rs139071351) in 2160 MS patients and 886 controls from Canada identified ten additional probands, two sporadic patients and one control with the variant. Segregation in families harboring the rs139071351 variant, identified p.G420D in 26 out of 30 family members diagnosed with MS, 14 unaffected parents and 12 out of 30 family members not diagnosed with disease. Despite considerably reduced penetrance, linkage analysis supports co-segregation of PLG p.G420D and disease. Genotyping of PLG p.G420D in 14446 patients and 8797 controls from Canada, France, Spain, Germany, Belgium and Austria failed to identify significant association with disease (p=0.117), despite an overall higher prevalence in patients (OR=1.32; 95% CI=0.93-1.87). To assess whether additional rare variants have an effect on MS risk, we sequenced PLG in 293 probands and genotyped all rare variants in cases and controls. This analysis identified nine rare missense variants, and although three of them were exclusively observed in MS patients segregation does not support pathogenicity. PLG is a plausible biological candidate for MS owing to its involvement in immune system response, blood-brain barrier permeability and myelin degradation. Moreover, components of its activation cascade have been shown to present increased activity or expression in MS patients compared to controls; further studies are needed to clarify whether PLG is involved in MS susceptibility.status: publishe

Analysis of Plasminogen Genetic Variants in Multiple Sclerosis Patients.

Multiple sclerosis (MS) is a prevalent neurological disease of complex etiology. Here, we describe the characterization of a multi-incident MS family that nominated a rare missense variant (p.G420D) in plasminogen (PLG) as a putative genetic risk factor for MS. Genotyping of PLG p.G420D (rs139071351) in 2160 MS patients, and 886 controls from Canada, identified 10 additional probands, two sporadic patients and one control with the variant. Segregation in families harboring the rs139071351 variant, identified p.G420D in 26 out of 30 family members diagnosed with MS, 14 unaffected parents, and 12 out of 30 family members not diagnosed with disease. Despite considerably reduced penetrance, linkage analysis supports cosegregation of PLG p.G420D and disease. Genotyping of PLG p.G420D in 14446 patients, and 8797 controls from Canada, France, Spain, Germany, Belgium, and Austria failed to identify significant association with disease (P = 0.117), despite an overall higher prevalence in patients (OR = 1.32; 95% CI = 0.93-1.87). To assess whether additional rare variants have an effect on MS risk, we sequenced PLG in 293 probands, and genotyped all rare variants in cases and controls. This analysis identified nine rare missense variants, and although three of them were exclusively observed in MS patients, segregation does not support pathogenicity. PLG is a plausible biological candidate for MS owing to its involvement in immune system response, blood-brain barrier permeability, and myelin degradation. Moreover, components of its activation cascade have been shown to present increased activity or expression in MS patients compared to controls; further studies are needed to clarify whether PLG is involved in MS susceptibility

Analysis of Plasminogen Genetic Variants in Multiple Sclerosis Patients

Altres ajuts: This research was undertaken thanks to funding from the Canada Research Chair [950-228408] and Canada Excellence Research Chair programs [214444], Canadian Institutes of Health Research [MOP-137051], Vancouver Coastal Health Research Institute, the Milan & Maureen Ilich Foundation [11-32095000], and the Vancouver Foundation [ADV14-1597]. Replication studies received funding from the program "Investissements d'avenir" ANR-10-IAIHU-06. Junta de Andalucía -FEDER [grant number CTS2704 to F.M.]. B.D. is a Clinical Investigator of the Research Foundation Flanders (FWO-Vlaanderen). A.G. and B.D. are supported by the Research Fund KU Leuven (OT/11/087 and CREA/14/023) and the Research Foundation Flanders (G073415N). A.L.T. reports personal fees from Biogen Idec, Chugai, Medimmune, Teva Innovation, and EMD Serono, and grants and personal fees from Genzyme Sanofi and Roche. All other authors report no disclosures.Multiple sclerosis (MS) is a prevalent neurological disease of complex etiology. Here, we describe the characterization of a multi-incident MS family that nominated a rare missense variant (p.G420D) in plasminogen (PLG) as a putative genetic risk factor for MS. Genotyping of PLG p.G420D (rs139071351) in 2160 MS patients, and 886 controls from Canada, identified 10 additional probands, two sporadic patients and one control with the variant. Segregation in families harboring the rs139071351 variant, identified p.G420D in 26 out of 30 family members diagnosed with MS, 14 unaffected parents, and 12 out of 30 family members not diagnosed with disease. Despite considerably reduced penetrance, linkage analysis supports cosegregation of PLG p.G420D and disease. Genotyping of PLG p.G420D in 14446 patients, and 8797 controls from Canada, France, Spain, Germany, Belgium, and Austria failed to identify significant association with disease (P = 0.117), despite an overall higher prevalence in patients (OR = 1.32; 95% CI = 0.93-1.87). To assess whether additional rare variants have an effect on MS risk, we sequenced PLG in 293 probands, and genotyped all rare variants in cases and controls. This analysis identified nine rare missense variants, and although three of them were exclusively observed in MS patients, segregation does not support pathogenicity. PLG is a plausible biological candidate for MS owing to its involvement in immune system response, blood-brain barrier permeability, and myelin degradation. Moreover, components of its activation cascade have been shown to present increased activity or expression in MS patients compared to controls; further studies are needed to clarify whether PLG is involved in MS susceptibility