P1552CAN WE GET ADEQUATE DIALYSIS WITH LIQUID AT 300 ML/MIN ?

Background and Aims

The portable HD monitors achieve a good adaptation with HD dialysate at 200ml / min using the concept of saturation of the HD dialysate. We decrease from 800ml / min to 500ml / min with good adaptation some years ago.

To assess the effectiveness of HD in both HD-standard and HDF-online with dialysate flow at 300ml / min by establishing approximate mathematical model of clearance.

Methods

We conducted an HD session with dialysate flow at a speed of 300ml / min, half week session to 52 patients in our unit. We value vascular access, session time, liters of blood-purified and total infusion in HDF online. We review HD monitor and dialyzer.

We perform pre and postHD blood determinations: Urea, B2microglobulin, P and uric acid, assessing urea reduction rate (PRU), b2microglobulin reduction rate (PR2microg) with both dialysate flows at 300ml / min and 500ml / min. We also have evaluated the differences between the two methods.

In the HD dialysate flow we determine at 300ml / min at 5, 10, 30, 45 and 60min (total dialysate collection in the first hour with sample of the mixture) urea, B2microg, Uric acid and P and at 2, 3 and 4 hours establishing a mathematical model with an approximation curve in both HD and online HDF.

Results

Five patients in standard HD (4h), 35 HDF online (4h) (x Liters infused 24.87 ± 2.79 l) and 12 short-daily HD (2h30min). 18 catheter and 34 FAV. Xliters purified blood = HD daily 54.41 ± 5.63l, HD standard 87.38 ± 6.01 and HDFonline 82.02 ± 16.13l.

The xPRU = 76.17 ± 10.49%, PRB2microg = 73.82 ± 13.49, Kt / V = 1.52 ± 0.28. By scheme at 300ml / min of HD fluid flow: HDFonline xPRU = 81.54 ± 5.25, Standard HD = 78.01 ± 3.03, Daily HD = 60.19 ± 6.71; xPRb2microg HDFonline = 76.70 ± 14.76%, Standard HD 65.44 ± 11.81, Daily HD = 69.16 ± 6.49.

Comparing the xPRU at 300ml / min of liquid vs 500ml / min we didn´t found significant differences, nor in the x preHD of urea and B2microglobulin.

With the dialysate samples we obtain a polynomial model of order 7 allowing cuantitative adjustment of the curve.R2 0.9, observing in the first 2 hours the greater removing.

Conclusions

1. The results are sufficient to consider the result of the removing in each scheme adequate. 2. The decrease in costs would be important (40% of water + energy saving and longer duration elements water treatment. 3. Further study are necessary.

Relationship between plasma bilirubin level and oxidative stress markers in HIV-infected patients on atazanavir- vs. efavirenz-based antiretroviral therapy

OBJECTIVES

Chronic oxidative stress (OS) may play a role in cardiovascular disease in HIV-infected patients, and increased bilirubin levels may have a beneficial role in counteracting OS. Atazanavir (ATV) inhibits UDP-glucuronosyl-transferase 1A1 (UGT1A1), thus increasing unconjugated bilirubin levels. We aimed to compare changes in OS markers in patients on ATV/ritonavir (ATV/r)- vs. efavirenz (EFV)-based first-line antiretroviral therapy (ART).

METHODS

A multicentre, prospective cohort study of HIV-infected patients who started first-line ART with either ATV/r or EFV was conducted. Lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO) and oxidized low-density lipoprotein (oxLDL) were measured for 145 patients in samples obtained at baseline and after at least 9 months of ART during which the initial regimen was maintained and the patient was virologically suppressed. The change in OS markers was modelled using multiple linear regressions adjusting for baseline values and confounders.

RESULTS

After adjustment for baseline variables, patients on ATV/r had a significantly greater decrease in Lp-PLA2 [estimated difference -16.3; 95% confidence interval (CI) -31.4, -1.25; P = 0.03] and a significantly smaller increase in OxLDL (estimated difference -21.8; 95% CI -38.0, -5.6; P < 0.01) relative to those on EFV, whereas changes in MPO were not significantly different (estimated difference 1.2; 95% CI -14.3, 16.7; P = 0.88). Adjusted changes in bilirubin were significantly greater for the ATV/r group than for the EFV group (estimated difference 1.33 mg/dL; 95% CI 1.03, 1.52 mg/dL; P < 0.01). Changes in bilirubin and changes in OS markers were significantly correlated.

CONCLUSIONS

When compared with EFV, ATV/r-based therapy was associated with lower levels of oxidative stress biomarkers, which was in part attributable to increased bilirubin levels.

[Present situation and future perspectives of the epidemic of HIV and AIDS in Spain]

Until 1997 Spain was the European country with the highest incidence of AIDS, due mainly to transmission between users of injected drugs. Since early 1990 there has been a fall in the rate of diagnoses of HIV infection in the Spanish autonomous communities where this information is available, and in 2004 this rate was situated below that of several western European countries. New infections in users of intravenous drugs have declined, and although heterosexual transmission has not undergone significant changes, it has become the prime cause of new HIV infections. The rate of diagnoses of HIV has fallen in both the indigenous population and immigrants; however, demographic changes have meant an increase in the percentage of HIV diagnoses in immigrants. In homosexual men there have been descriptions of a recent increase in the incidence of syphilis and gonococcus, which are a warning of possible increases in the transmission of HIV in this group. The number of people who live with HIV in Spain remains between 100,000 and 150,000 (2.4 to 3.6 per 1,000 inhabitants). In spite of the improvement in prognosis due to antiretroviral treatments, there are annually in Spain over 2,000 cases of AIDS (4.8 per 100,000 inhabitants) and over 1,600 deaths from AIDS (3.8 per 100,000). One third of the people who developed AIDS in 2004 had not until then been diagnosed with HIV, which prevented starting the antiretroviral treatment in time.

[HIV prevalence among homosexual and bisexual men in Spain, 1992-2000]

BACKGROUND

Our purpose was to describe the time trend in HIV seroprevalence among homo/ bisexual men.

SUBJECTS AND METHOD

We analyzed 9,383 homo/ bisexual men who had a first voluntary test for HIV in 10 Spanish clinics from 1992 to 2000.

RESULTS

HIV prevalence decreased from 20.3% in 1992 to 8.4% in 2000. In the multivariate analysis this decline appeared independently associated with the testing year and the birth cohort.

CONCLUSIONS

New generations of voluntarily tested homo/bisexual men are less infected by HIV, but it is yet necessary to intensify the prevention programs.

Cholesterol levels in untreated Spanish hypertensive patients. The Compas Study Group, Spanish Hypertension Society

In daily practice, arterial hypertension (AHT) and hypercholesterolaemia are frequently associated with the existence of multiple common etiopathogenic interrelationships. This situation leads to an exponential increase in cardiovascular risk for these patients, so it is essential to know the prevalence and therapeutic management of hypercholesterolaemia in the hypertensive patient. This national study analyses the distribution of total cholesterol levels and low-density lipoprotein cholesterol as well as hypercholesterolaemia prevalence and its therapeutic management in the uncontrolled hypertensive Spanish population. We observed mean total cholesterol levels of 227+/-41 mg/dl with a high prevalence of hypercholesterolaemia (34.2%) among hypertensive patients, and the percentage of those patients with "desirable" total cholesterol levels (<200 mg/dl) was <25%. The treated hypertensive patients presented both significantly higher mean cholesterol levels and greater hypercholesterolaemia prevalence than the untreated hypertensive patients. It appears that total cholesterol levels are scarcely related to the presence or non-presence of obesity, diabetes or smoking. Regarding treatment, only 14.6% of the hypercholesterolaemic hypertensive patients received hypolipaemic treatment with statins. These results support the need to introduce measures for better diagnostic and therapeutic management of hypercholesterolaemic hypertensive patients that will lead to a much higher reduction in cardiovascular risk for these patients.

Role of interferon alfa-2b in the induction and maintenance treatment of low-grade non-Hodgkin's lymphoma: results from a prospective, multicenter trial with double randomization

PURPOSE

To evaluate the effectiveness of adding interferon (IFN) alfa-2b to chemotherapy in the induction treatment of low-grade non-Hodgkin's lymphoma (NHL), and to assess the role of maintenance IFN.

PATIENTS AND METHODS

A multicenter, two-phase controlled trial with double randomization was conducted in 155 patients with low-grade NHL. In the first randomization, 78 patients received cyclophosphamide, vincristine, and prednisone (CVP) and IFN, 3 MU/m2 three times a week for 3 months, and 77 patients received CVP alone. Responding patients were randomized to receive IFN for 1 year versus observation.

RESULTS

Of 144 assessable patients, 73 received CVP + IFN and 71 received CVP. Responses were similar: CVP + IFN 79% versus CVP 76% (P = .62). The number of patients who did not complete the treatment was higher in the CVP + IFN group than in the CVP group (18% v 4%; P = .009), although the received dose-intensity of chemotherapy was comparable. Duration of response and progression-free survival (PFS) were significantly higher in the CVP + IFN group than in the CVP group (P = .0004). However, we observed no differences in overall survival (OS) (P = .30), with a median follow-up for the surviving patients of 3 years. Grade 3/4 granulocytopenia was the most frequent toxicity and was similar in both groups (33% v32%). Eighty-three (74%) of the 112 responding patients were randomized to maintenance IFN or observation. The duration of response was similar between 42 patients that received IFN compared with 41 control patients (P = .83), independently of treatment previously administered.

CONCLUSION

Adding IFN alfa-2b to induction CVP in low-grade NHL did not induce a higher response rate, but it significantly increased the duration of the responses. We found significant differences in PFS that favored the patients who received CVP + IFN, but not in OS. To date, no additional benefit has been seen from the administration of IFN for maintenance.