BackgroundHemodiafiltration (HDF), as a convective blood purification technique, has been associated with favorable outcomes improved phosphate control, removal of middle-molecules such as Beta2-microglobulin and the occurrence of intradialytic hypotension (IDH) as compared to diffusive techniques. The aim of this retrospective cohort study in dialysis patients receiving HDF in one urban dialysis facility in Mexico City was to investigate the occurrence of IDH during HDF treatments with varying convective volume prescriptions.MethodsSubjects were stratified into equal groups of percentiles of convective volume prescription: Group 1 of 0 to 7.53 liters, group 2 of 7.54 to 14.8 liters, group 3 of 14.9 to 16.96 liters, group 4 of 16.97 to 18.9 liters, group 5 of 21 to 19.9 liters and group 6 of 21.1 to 30 liters. Logistic Regression with and without adjustment for confounding factors was used to evaluate factors associated with the occurrence of IDH.Results2276 treatments of 154 patients were analyzed. IDH occurred during 239 HDF treatments (10.5% of all treatments). Group 1 showed 31 treatments (8.2%) with IDH whereas group 6 showed IDH in only 15 sessions (4% of all treatments). Odds Ratio of IDH for Group 6 was 0.47 (95% CI 0.25 to 0.88) as compared to Group 1 after adjustment.ConclusionsIn summary the data of this retrospective cohort study shows an inverse correlation between the occurrence of IDH and convective volume prescription. Further research in prospective settings is needed to confirm these findings.

Background: In hemodialysis, extracorporeal blood flow (Qb) recommendation is 300-500 mL/ min. To achieve the best Qb, we based our prescription on dynamic arterial line pressure (DALP).

BackgroundCancer antigen (CA) 125 (CA-125) is used in ovarian cancer detection and monitoring, whose serum level has a positive correlation with tumor stage. The aim of this study was to obtain a prediction metastasis equation in a group of patients with ovarian cancer based on Ca-125.MethodsA 2-group comparative observational study was conducted at a single oncologic institution (SOLCA) in Cuenca-Ecuador. All patients who were diagnosed with ovarian cancer between January 1996 and December 2016 were included in the current study. Group 1 (G1) patients with the I and II International Federation of Gynecology and Obstetrics (FIGO) stage and Metastasis Group (MG), with III and IV stage, were subdivided. A logistic regression equation was performed to predict metastasis based on Logarithm of serum Ca-125 levels.ResultsWe included 85 cases in G1 and 64 patients in MG, with 47.8 ± 15 years (G1) and 57.5 ± 13.6 years (MG) of age (P < 0.001). Mortality in G1 was 2 cases (3.1%) and 53 cases (62.4%) in MG (P < 0.001). The CA-125 serum level was 163.5 ± 236 in G1 and 1220.9 ± 1940 u / ml in MG (P < 0.001). The equation to predict metastasis = (Age*0.053) + [(Logarithm Ca-125 value) * 1.078] − 8.163 with an OR 2.940 (CI 95% 2.046–4.223) P < 0.001. The sensitivity of the equation was 82.4% and the specificity was 79.7%.ConclusionsIt is possible to predict the presence of metastasis in a group of patients with ovarian cancer based on Ca-125.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4499-y) contains supplementary material, which is available to authorized users.

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The aim of this study was to evaluate the factors that prevent dry weight achievement in patients with end-stage renal disease (ESRD) in renal replacement therapy through the change in their body weight after kidney transplant (KT) compared with 1 week before KT. The study included 188 ESRD patients of diverse etiology who received living kidney transplantation with normal immediate graft function, 62.2% were male, age 29 ± 11 years old. All patients were on renal replacement therapy for at least 1 month before KT with either hemodiafiltration (N = 106), hemodialysis (N = 25), or peritoneal dialysis (N = 57). Based on body weight difference (after transplant-before transplant), patients with body weight difference ≤2 kg were considered as being close to their dry weight (Group 1, N = 112), whereas patients with body weight difference >2 kg were considered as being overhydrated (Group 2, N = 76). Clinical and biochemical characteristics were obtained from the medical records at three periods of time: time of ESRD initiation (baseline), 1 week before undergoing KT, and 1 week after KT. The mean time (± standard deviation) from renal replacement therapy initiation to the week before KT was 9.2 ± 5 months. Group 2 had a higher proportion of men, antihypertensive use, peritoneal dialysis, and higher urine output during all periods. Before KT, Group 2 had higher systolic and diastolic blood pressures than Group 1. After KT, both systolic and diastolic blood pressures decreased in Group 2, whereas no change occurred in Group 1. Before KT, Group 2 had higher levels of blood urea nitrogen, creatinine, uric acid, and phosphorous compared with Group 1. Compared with baseline, Group 1 had more optimal blood urea nitrogen, creatinine, and uric acid parameters before KT than Group 2. After KT, all parameters improved with respect to baseline in both groups. Hemoglobin, albumin, and sodium were similar between groups, except for higher hemoglobin in Group 2 than Group 1 after KT. Multivariate regression analysis showed that male sex, peritoneal dialysis, and systolic blood pressure before KT were independent risk factors for overhydration. In conclusion, high systolic blood pressure and peritoneal dialysis were two independent modifiable variables associated with overhydration before KT. Assessment of the body weight change after KT is a useful tool to evaluate dry weight, in addition to identifying variables associated with poor volume control. This could allow adjustment of clinical and dialysis parameters in future patients.