Santiago-Córdova JL, Rodríguez-López L, Sánchez-Hernández G

Language: Spanish
References: 20
Page: 479-486
PDF size: 195.98 Kb.

ABSTRACT

Background: Anemia increases morbidity and mortality due to cardiovascular complications (angina, heart failure and left ventricular hypertrophy), which can lead to further deterioration of renal function and to the establishment of an anemic cardiorenal syndrome.
Objective: To measure levels of hemoglobin, calcium and phosphorus in patients with chronic kidney disease (CKD) stage 5 who are receiving erythropoietin and to establish whether there is any correlation among these variables.
Material and methods: A descriptive, observational, crosssectional and prolective study was made in which it was determined a sample of 24 patients (men and women) with chronic kidney disease (CKD) stage 5 in replacement therapy of renal function with CAPD (continuous ambulatory peritoneal dialysis) and refractory anemia. Samples were taken for measurement of hemoglobin, phosphate (P04) and calcium (Ca) and solubility product (product calcium x phosphorus) was calculated. To correlate variable hemoglobin with variables calcium and phosphate inferential statistics was used by coefficient of Pearson correlation. It also was calculated determination coefficient. For calculating p value distribution t was used and values of 0.05 were considered statistically significant.
Results: From patients included 12 were female and 12 male, with an age mean of 45.5 years. Correlation between variable hemoglobin and solubility product resulted negative, with an r of -0.433 (95% CI -.034 to -.711) and determination coefficient of 18%, with a confident interval of 95% with p ‹ 0.05.
Conclusions: There is statistically significant negative correlation between the level of Hb and P04 levels and PS, which could indicate that the increase in P04 and Ca favor the refractory anemia in patients with CKD stage 5 in chronic ambulatory peritoneal dialysis (CAPD).

REFERENCES

1. Besarab A. Defining a renal anemia management period. AmJ Kidney Dis 2000;36:S13-23.

2. Levin A, Singer J, et al. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis 1996;27:347-354.

3. Muzzarelli S, Pfisterer M. Anemia as independent predictor of major events in elderly patients with chronic angina. Am Heart J 2006;152:991-996.

4. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA 2007;298:2038-2047.

5. Levin A. KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis 2006;47:S11-15

6. Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from kidney disease: improving global outcomes (KDIGO). Kidney Int 2005;67:2089-2100.

7. McClellan W, Aronoff SL, Bolton WK, et al. The prevalence of anemia in patients with chronic kidney disease. Curr Med Res Opin 2004;20:1501-1510.

8. Dowling TC. Prevalence, etiology, and consequences of anemia and clinical and economic benefits of anemia correction in patients with chronic kidney disease: an overview. Am J Health Syst Pharm 2007;64:S3-7.

9. Slatopolsky E, Brown A Dusso A. Pathogenesis of secondary hyperparathyroidism. Kidney Int SuppI 1999;73:S14- S19

10. Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 1998;31:607- 617.

11. Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK. Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 2001;12:2131-2138.

12. Brown AJ, Finch J, Slatopolsky E. Differential effects of 19-nor- 1 ,25-dihydroxyvitamin D(2) and 1,25-dihydroxyvitamin D(3) on intestinal calcium and phosphate transport. J Lab Clin Med 2002, 139:279-284.

13. Finch JL, Brown AJ, Slatopolsky E. Differential effects of 1,25-dihydroxy- vitamin D3 and 19-nor-1 ,25-dihydroxyvitamin D2 on calcium and phosphorus resorption in bone. J Am Soc Nephrol 1999;10:980-985.

14. Brandi L, Egfjord M, Olgaard K. Pharmacokinetics of 1,25(OH)(2)D(3) and 1alpha(OH)D(3) in normal and uraemic men. Nephrol Dial Transplant 2002;17:829-842.

15. Nielsen PK. A direct inhibitory effect of 1a-hydroxyvitamin D3 on PTH secretion from bovine parathyroid glands. J Am Soc Nephrol 1997;8:578A.

16. The Danish Society of Nephrology Danish National Registry Annual Report 2007 [http://www.nephrology.dk].

17. National Kidney Foundation. KDOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. http://www.kidney.org/professionals/ kdoqi/guidelines_bone/index.htm. Accessed September 16, 2009.

18. Rodriguez A, Martin A, Alvarez-Lara MA, Rodriguez M, Aljama P. Mild hyperphosphatemia and mortality in hemodialysis patients. Am J Kidney Dis 2005;46:68-77.

19. Tentori F, Blayney M, Albert J, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2008;52:519- 530.

20. Goodman WG. The consequences of uncontrolled secondary hyperparathyroidism and its treatment in chronic kidney disease. Semin Dial 2004;17:209-216.