Correction to: Incidence and characteristics of methicillin‑resistant coagulase‑negative Staphylococcus in peritoneal dialysis‑associated peritonitis in a single center using molecular methods

International Urology and Nephrology - In the original publication, article title was incorrectly published.     

White‐coat and masked hypertension diagnoses in chronic kidney disease patients

The purpose of this study was to analyze which 24‐hour ambulatory blood pressure measurement (ABPM) parameters should be used on masked hypertension (MH) and white‐coat hypertension (WCH) diagnoses in chronic kidney disease (CKD) patients. Non‐dialysis CKD patients underwent 24‐hour ABPM examination between 01/27/2004 and 02/16/2012. They were followed from the 24‐hour ABPM to January/2014 in an observational study. The WCH definitions tested were as follows: (a) office blood pressure (BP) ≥ 140/90 mm Hg and daytime ABPM BP ≤ 135/85 mm Hg (old criterion); and (b) office BP ≥ 140/90 mm Hg and 24‐hour ABPM BP ≤ 130/80 mm Hg, daytime ABPM BP ≤ 135/85 mm Hg, and nighttime ABPM BP ≤ 120/70 mm Hg (new criterion). The MH definitions tested were as follows: (a) office BP < 140/90 mm Hg and daytime ABPM BP > 135/85 mm Hg (old criterion); and (b) office BP < 140/90 mm Hg and 24‐hour ABPM BP > 130/80 mm Hg or daytime ABPM BP > 135/85 mm Hg or nighttime ABPM BP > 120/70 mm Hg (new criterion). The two definitions' predictive capacity was compared, regarding both WCH and MH. Cardiovascular mortality was the primary and all‐cause mortality was the secondary outcome. Cox regression was adjusted to the variables: glomerular filtration rate, age, diabetes mellitus, and active smoking. There were 367 patients studied. The old criterion (exclusive mean daytime ABPM BP) was the only to distinguish sustained hypertension from WCH (adjusted HR: 3.730; 95% CI: 1.068‐13.029; P = .039), regarding all‐cause mortality. Additionally, the old criterion was the only one to distinguish normotension and MH, regarding cardiovascular mortality (adjusted HR: 7.641; 95% CI: 1.277‐45.738; P = .026). Therefore, WCH and MH definitions based exclusively on daytime ABPM BP values (old criterion) were able to better distinguish mortality in this studied CKD cohort.     

Validity of malnutrition scores for predicting mortality in chronic hemodialysis patients

Purpose

Malnutrition is a strong predictor of mortality in hemodialysis patients. Several scoring systems for evaluating nutritional status have been proposed. However, they rely on different sets of anthropometric and laboratory markers to make a diagnosis of malnutrition and assess its impact on prognosis. To validate them, nutritional scores should be compared with clinical outcomes. Thus, the purpose of this study was to assess malnutrition by three different nutrition scoring systems and determine which best predicts mortality in hemodialysis patients.

Methods

This prospective study included 106 adult chronic hemodialysis patients. Their mean age was 56.3 ± 14.9 years and mean body mass index 24.8 (21.8–28.9); 52 % were men and they had been on dialysis for 24 (5–55) months. Nutritional status was classified according to the diagnostic systems proposed by Wolfson et al. (Am J Clin Nutr 39(4):547–555, 1984), International Society of Renal Nutrition and Metabolism (ISRNM) (Fouque et al. in Kidney Int 73(4):391–398, 2008), and Beberashvili et al. (Nephrol Dial Transplant 25(8):2662–2671, 2010). During about 2 years of follow-up, mortality was assessed by Kaplan–Meier curves, log-rank, and Cox’s models adjusted for diabetes, sex, C-reactive protein, time on dialysis, age, and fractional urea clearance.

Results

Twenty-three deaths (21.5 %) occurred during the study period. According to the systems of Wolfson, Beberashvili, and the ISRNM, 54, 32, and 20 % of patients, respectively, had malnutrition. Both univariate and multivariate analyses showed that the ISRNM system was the only one that predicted poorer survival (fourfold higher death risk) in malnourished patients.

Conclusions

The scoring system proposed by the ISRNM most accurately identifies patients at higher risk of death.     

The effects of motor learning on clinical isokinetic performance of postmenopausal women

Objective

To analyze the effects of motor learning on knee extension–flexion isokinetic performance during clinical isokinetic evaluation of postmenopausal women.

Methods

One-hundred and twenty postmenopausal women (60.3 ± 3.2 years; BMI = 27.6 ± 4.7 kg/m²) without knee pain or injury and that never underwent isokinetic testing, were submitted to two bilateral knee extension–flexion (concentric–concentric) isokinetic evaluation (5 repetitions) at 60°/s (Biodex™ Multi-Joint System 3 dynamometer). The tests were first performed in the dominant leg, with a 1-min recovery between them, and after a standardized warm-up that included 3 submaximal isokinetic repetitions. The same procedure was repeated in the non-dominant leg. Peak torque (PTQ) was adjusted for body weight (PTQ/BW), total work (TW), coefficient of variation (CV) and agonist/antagonist (agon/antag) ratio was compared between tests.

Results

Subjects showed greater levels (P < 0.001) of PTQ, PTQ/BW and TW, and lower CV levels (P < 0.01) in test 2 of both legs. Agon/antag ratio did not change significantly between tests.

Conclusions

PTQ, PTQ/BW, TW and CV improved in the second knee extension flexion isokinetic testing of postmenopausal women. The results suggests that performing two tests, even with a short period of recovery between them, could be considered for reducing motor learning effects on clinical isokinetic evaluation of knee joint in postmenopausal women.     

Markers of uremia and pericardial effusion in peritoneal dialysis

Background

Inadequate dialysis causes accumulation of toxic residues that may lead to the development of dialysis-associated pericardial effusion, but several other factors could be associated with this abnormality. The purpose of this study was to evaluate clinical risk factors to asymptomatic pericardial effusion in peritoneal dialysis.

Methods

This cross-sectional study included 34 patients aged ??18?years on peritoneal dialysis for at least 3?months, who showed no symptomatic pericardial effusion, hepatic cirrhosis, neoplasias, lupus or amputations, none in minoxidil use. Asymptomatic pericardial effusion was diagnosed by echocardiography. Risk factors were evaluated by logistic regression and Roc curve. Significance level was set at P?Results Patient age was 51?±?15.9?years. Of the 34 patients enrolled, 16 were men and 11 diabetic. Five of them presented pericardial effusion. Logistic regression identifies low hemoglobin level (RR 0.454 CI 95%: 0.225?C0.913; P?=?0.027), low phase angle (RR 0.236 CI 95%: 0.057?C0.984; P?=?0.048) and low Kt/V (RR 0.001 CI 95%: 0.0?C0.492; P?=?0.03) as risk factors to pericardial effusion. Roc curve showed that hemoglobin levels below 12.2?g/dL, Kt/V lower than 1.9 and phase angle lower than 4.5° were the best cutoffs to predict pericardial effusion. Four patients showed these three parameters in the unfavorable range, and all these four patients presented pericardial effusion. The other patient with pericardial effusion had two of these parameters reduced.

Conclusions

These findings corroborate the hypothesis that uremia plays a significant role in the pathogenesis of dialysis-associated pericardial effusion.