Search PubMed⌕ Search

Biomedical subjects

R Selgas

Publications and source records attributed to R Selgas.

141 records · Page 8Linked to original sources
PubMedDate not supplied

Increased response to subcutaneous erythropoietin on type I diabetic patients on CAPD: is there a synergistic effect with insulin?

OBJECTIVE: To evaluate the effect of subcutaneous erythropoietin (SC EPO) on the treatment of anemia in diabetic and nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: A resistance index was designed for measuring the relative EPO response, dividing EPO dose (U/kg/week) by the hemoglobin (Hb) increment with respect to the basal level. PATIENTS: Eleven nonselected type I diabetic patients using subcutaneous insulin compared with 16 nondiabetic controls, all on CAPD therapy. RESULTS: The two groups showed similar mean baseline hemoglobin levels (7.4 D-I and 7.7 non-D, g/dL). There was a statistically significant lower resistance index for diabetics (13.8 +/- 9.7 U/kg/g Hb increment) compared to nondiabetic (55.8 +/- 128, p < 0.001). Multivariate analysis confirmed an independent association between diabetes and resistance index. The response to EPO was slightly better among those diabetic patients with lower levels of serum parathyroid hormone (iPTH) (PTH-resistance index, correlation coefficient, r = 0.7, p < 0.05). No other differences, apart from the use of subcutaneous insulin, were found between diabetics and controls. Although diabetic patients had an increased response to EPO, they had no more frequent side effects than nondiabetics. CONCLUSIONS: According to our results, we suggest that factors related to insulin-dependent diabetes seem to be involved in a favorable response to SC EPO. Hyperinsulinemia derived from subcutaneous use of insulin might act as a comitogen with the induced increments of serum erythropoietin.

Adult↗
PubMedDate not supplied

[The present and future of continuous ambulatory peritoneal dialysis (CAPD)].

In order to establish an idea of the future of continuous ambulatory peritoneal dialysis, it is necessary to know the present application of this method, which if it used for a greater number of patients each time, it is performed occasionally with deficient resources and on patients nor selected properly. A possible solution is a very well established peritoneal dialysis program which can "support" an active renal transplant program. It would be interesting to make a prospective and aleatory study between peritoneal dialysis and hemodialysis. It is required to improve: the disconnecting system to the peritoneal catheter, the subcutaneous implantation method, to use the adequacy of the dialysis concept, to design methods to favor the duration and durability of the human peritoneum and look deeply into the opportune and correct treatment of peritonitis and to increase the automatic peritoneal dialysis systems. In the future of peritoneal dialysis we cannot overlook looking deeply into the peritoneum cellular biology in order to use the peritoneum taking into consideration the biology of its cells. DPCA has a bright future and it should play a more important role in the treatment of uremia.

Humans↗
PubMedDate not supplied

Transformed mesothelial cells in patients on CAPD for medium- to long-term periods.

OBJECTIVE: To describe the characteristics of abnormal cells present in the peritoneal effluent of 4 continuous ambulatory peritoneal dialysis (CAPD) patients; the cells were accidentally detected in a longitudinal study of cell populations in 83 patients. DESIGN: Descriptive study. PARTICIPANTS: Four stable CAPD patients (2 male, 2 female). INTERVENTIONS: Peritoneal cells were collected from nocturnal peritoneal effluent (NPE) by centrifugation. MEASUREMENTS: Light microscopy, ultrastructural, cytochemical, and immunohistochemical characteristics were studied. RESULTS: The abnormal cells were characterized by a flat appearance, large size (diameter 100 microns)--six to ten times larger than a normal macrophage, a broad acidophilic cytoplasm with rare granulations, and a low nucleus/cytoplasm ratio. The nucleus was pyknotic, with dense chromatin and sometimes appeared fragmented. Its number presented a considerable variability between the patients and was much higher in the 2 females. This number remained stable in each patient over time. These cells were negative for beta-glucuronidase and positive for PAS stain with variable intensity. A very low number of flat cells were positive for vimentin with weak intensity, whereas cytokeratin and epithelial membrane antigen (EMA) were positive in a higher number of cells with medium to strong intensity. Ultrastructural studies showed numerous short surface microvilli, cytoplasm well-developed with intracytoplasmic lumina and abundant, dispersed intermediate filaments, scattered mitochondria, and stacks of rough endoplasmic reticulum were observed. Dispersed secretory vacuoles and isolated lipid vacuoles were present. CONCLUSION: All these features imply that they are mesothelial in origin and are suggestive of a change known as peritoneal squamous metaplasia. To date, the clinical follow-up of our patients has shown a benign outcome; further studies are necessary to elucidate the significance of this peritoneal squamous metaplasia in CAPD patients.

Adult↗
PubMedDate not supplied

Long-term continuous ambulatory peritoneal dialysis reduces the expression of CD11b, CD14, CD16, and CD64 on peritoneal macrophages.

OBJECTIVE: To characterize phenotypically the macrophages from nocturnal peritoneal effluent (NPE) in patients on continuous ambulatory peritoneal dialysis (CAPD), and to determine the influence of the length of this therapy on macrophage (M phi) function. DESIGN: Cross-sectional descriptive study. PATIENTS: Fifty-five patients on CAPD who were classified into short-, medium-, and long-term groups according to their time on CAPD. Peritoneal macrophages (PM phi) were also characterized in 7 patients at the time of catheter placement, and there were 13 normal controls. INTERVENTIONS: Macrophages were collected from NPE by centrifugation. MEASUREMENTS: Membrane receptor expression was evaluated by flow cytometry analysis. RESULTS: Flow cytometry analysis revealed that the expression of CD11b, CD16, CD64, and CD14 on NPE macrophages was reduced during the course of CAPD treatment, reaching levels which represented a 40%-50% reduction of the cell surface expression detected at the start of the treatment or on normal control macrophages. Both normal and CAPD PM phi expressed CD4, CD69, and CD71 very weakly and lacked CD25. No changes in HLA-DR or in other adhesion protein (CD11a, CD11c, CD18, CD54) expression were detected, and levels were similar in both patients and normal controls. CONCLUSION: Our results show that long-term CAPD might affect Fc gamma receptor-mediated phagocytosis by reducing the expression of CD16, CD64, and CD11b. Lower CD11b and CD14 expression would also impair PM phi adhesion to mesothelial structures.

Adult↗
PubMedDate not supplied

Erythropoietin treatment decreases cardiovascular morbidity and mortality in CAPD patients.

OBJECTIVE: To analyze the effects of recombinant human erythropoietin (rHuEPO) therapy on cardiovascular (CV) morbidity and mortality among continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: Retrospective comparative study. SETTING: CAPD unit in a university hospital. PATIENTS: Forty-two patients on rHuEPO treatment for at least one year were compared with an rHuEPO nonuser group of 113 patients. Subcutaneous rHuEPO doses were adjusted to a hemoglobin objective level of 10.5-13.5 g/dL. Fifty-seven patients were considered as high cardiovascular risk (HCVR), 17 in the rHuEPO group and 40 in the rHuEPO nonuser group. Ninety-eight patients were classified as low cardiovascular risk (LCVR), 25 of whom were in the rHuEPO group. RESULTS: The incidence of cardiovascular morbidity was more frequent in the rHuEPO nonuser than in the rHuEPO user group (40% vs 22%) and in HCVR than in LCVR patients (59.6% vs 20.4%). By multiple logistic regression analysis, the best model to explain the development of cardiovascular morbidity comprises rHuEPO treatment, CV risk, and age. In the rHuEPO user group, HCVR and LCVR patients did not show significant differences in survival, while in the rHuEPO nonuser group, HCVR patients had a lower survival rate than LCVR patients (p = 0.0003). Cox proportional hazards model revealed that LCVR patients had an excellent prognosis compared with HCVR patients in the rHuEPO nonuser group, but this difference disappeared in the rHuEPO user group. CONCLUSION: These data show a beneficial effect of rHuEPO treatment on cardiovascular morbidity and mortality in CAPD patients, evidenced by the elimination of the correlation between prior cardiovascular risk and subsequent mortality.

Adult↗
PubMedDate not supplied

Erosive azotemic osteoarthropathy of the hands in chronic ambulatory peritoneal dialysis and hemodialysis.

OBJECTIVE: We studied the prevalence and significance of erosive azotemic osteoarthropathy (EAO) and its relationship with other osteoarticular abnormalities of dialysis-associated arthropathy (DAA). METHODS: 112 patients undergoing maintenance dialysis were studied: 63 hemodialysis (HD) and 49 continuous ambulatory peritoneal dialysis (CAPD). X-ray of the hands, shoulders, pelvis and cervical spine were examined for destructive spondyloarthropathy (SDA), bone cysts (BC), EAO and subperiosteal resorption. Beta 2-microglobulin (beta 2-m) and PTH were also measured. RESULTS: Fifteen patients (13%) had EAO, usually in several joints of the hands, DIPs being the most frequently affected. Both patients on HD and those on CAPD had EAO, although the prevalence was higher in the HD group, 12 (19%) vs. 3 (6%). Patients with EAO were older (p < 0.05) and had more carpal tunnel syndrome (CTS) (p < 0.05) and BC (p < 0.01). Only 3 out of 15 patients with EAO had severe secondary hyperparathyroidism (sHPTH) (PTH > 500), while 9/15 had neither radiologic nor laboratory evidence of sHPTH. No differences were found regarding the duration of dialysis, or beta 2-m or PTH level. CONCLUSION: EAO is not related to sHPTH and should be included within the spectrum of the clinical manifestations of DAA. Due to its location and radiologic picture, it is possible that etiologic factors leading to primary osteoarthritis may play a role in the development and evolution of EAO.

Adult↗