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Departamento de Medicina. Universidad de Alcalá, Guadalajara, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carbonato de lantano y disfunción de catéter peritoneal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11341_16025_30612_en_f1_1411341.jpg" "Alto" => 674 "Ancho" => 655 "Tamanyo" => 217242 ] ] "descripcion" => array:1 [ "en" => "Simple abdominal x-ray" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor,</span></p><p class="elsevierStylePara">Clinicians are frequently faced with relatively banal issues that become factors of diagnostic confusion or can even trigger more severe complications.</p><p class="elsevierStylePara">In patients treated with peritoneal dialysis, constipation can become a very difficult problem, and can even reach the point of completely impeding the drainage function of the peritoneal catheter.<span class="elsevierStyleSup">1</span> This is the result of displacement of the catheter towards the upper abdomen and the fact that, even with a properly positioned catheter, a rigid intestine hinders the recovery of infused peritoneal fluid. Over 50% of catheter dysfunctions are related to constipation, and at times this necessitates intensive laxative treatment.<span class="elsevierStyleSup">2</span> Constipation is also an issue in the development of hernias and complications from pressure on the abdominal wall, and can even facilitate the passage of bacteria from the intestinal lumen, leading to peritonitis.<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">Constipation can be associated with several different factors, such as a certain degree of intestinal paresis, insufficient mobility, and a diet low in fibre, which is often the result of diets that restrict the intake of fruits, and frequently is a result of the medications administered for concomitant problems. Several treatments administered to dialysis patients can generate or aggravate this situation, such as the resins used for hypercalcaemia and phosphate binders. Lanthanum carbonate is a phosphate binder, without calcium or aluminium, which is effective in controlling hyperphosphataemia, and being a radiopaque compound, results in very characteristic radiological images.<span class="elsevierStyleSup">4</span> However, as is the case in other chelating agents, it can produce constipation that is difficult to treat using conventional measures.<span class="elsevierStyleSup">5</span> A peritoneography can aid in the diagnosis of this type of mechanical issue.</p><p class="elsevierStylePara">We present the case of a patient in which the administration of lanthanum carbonate produced severe constipation and displacement of the catheter to the point where peritoneal dialysis treatment became impossible.</p><p class="elsevierStylePara">Ours was a 47 year-old patient with chronic renal failure from interstitial nephropathy secondary to reflux, who had been on haemodialysis since 1990. He underwent his first kidney transplant in 1991, which was then removed due to chronic dysfunction, and underwent a second transplant in 1999, which was again lost to the same reasons. He returned to haemodialysis in 2010. Due to intolerance to the second kidney, the patient underwent graft embolisation. He was receiving lanthanum carbonate at 750mg/8 hours due to secondary hyperparathyroidism and hyperphosphataemia. Due to several failed vascular accesses, it was suggested that the patient be transferred to peritoneal dialysis, and a straight, double-cuff Tenckhoff catheter was implanted. During training, we detected catheter malfunction with incomplete drainage, so we performed abdominal x-rays (Figure 1) and peritoneography (Figure 2). In addition to the remnants of the radio-opaque material from the graft embolisation, we observed a large quantity of faecal matter throughout the large intestine, with radiolucent images indicating the presence of lanthanum carbonate. The peritoneal catheter was poorly positioned towards the hepatic flexure of the colon, and the peritoneography dye was completely restricted between the transverse colon and the lower edge of the liver, which was clearly outlined, without disseminating into the rest of the abdominal cavity. Suspension of the lanthanum and intensive laxative treatment progressively resolved the constipation and dye restriction, although it did not resolve the poor positioning of the catheter, which had to be relocated.</p><p class="elsevierStylePara">The radiological images presented show the mechanism of action and the mechanical consequences.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article.</p><p class="elsevierStylePara"><a href="grande/11341_16025_30612_en_f1_1411341.jpg" class="elsevierStyleCrossRefs"><img src="11341_16025_30612_en_f1_1411341.jpg" alt="Simple abdominal x-ray"></img></a></p><p class="elsevierStylePara">Figure 1. Simple abdominal x-ray</p><p class="elsevierStylePara"><a href="grande/11341_16025_30613_en_f2_1411341.jpg" class="elsevierStyleCrossRefs"><img src="11341_16025_30613_en_f2_1411341.jpg" alt="Peritoneography"></img></a></p><p class="elsevierStylePara">Figure 2. Peritoneography</p>" "pdfFichero" => "P1-E536-S3514-A11341-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11341_16025_30612_en_f1_1411341.jpg" "Alto" => 674 "Ancho" => 655 "Tamanyo" => 217242 ] ] "descripcion" => array:1 [ "en" => "Simple abdominal x-ray" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11341_16025_30613_en_f2_1411341.jpg" "Alto" => 625 "Ancho" => 647 "Tamanyo" => 202186 ] ] "descripcion" => array:1 [ "en" => "Peritoneography" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Stuart S, Booth TC, Cash CJ, Hameeduddin A, Goode JA, Harvey C, et al. Complications of continuous ambulatory paritoneal dialysis. Radiographics 2009;29(2):441-60." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rodríguez-Palomares JR, Ruiz C, Granado A, Montenegro J. El acceso peritoneal. Guías de práctica clínica en diálisis peritoneal.\u{A0}\u{A0} Nefrologia\u{A0}2006;26 Suppl 4:1-184." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Stuart S, Booth TC, Cash CJ, Hameeduddin A, Goode JA, Harvey C, et al. Complications of continuous ambulatory peritoneal dialysis. Radiographics 2009;29(2):441-60." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kawanishi H, Ishida M, Ishizaki M, Takuma Y, Tamura H, Kobayashi S, et al.; Lanthanum Carbonate Study Group in Japan. Lanthanum carbonate treatment of patients with hyperphosphatemia undergoing CAPD.\u{A0}Perit Dial Int 2008;28(6):673-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18981401" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Camarero-Temiño V, Mercado-Valdivia V, Hijazi-Prieto B, Abaigar-Luquin P. Intestinal pseudo-obstruction secondary to persistent constipation due to lanthanum carbonate.\u{A0}Nefrologia 2012;32(1):129." 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2018 November | 97 | 18 | 115 |
2018 October | 93 | 13 | 106 |
2018 September | 67 | 18 | 85 |
2018 August | 67 | 23 | 90 |
2018 July | 60 | 12 | 72 |
2018 June | 60 | 16 | 76 |
2018 May | 67 | 11 | 78 |
2018 April | 79 | 5 | 84 |
2018 March | 70 | 10 | 80 |
2018 February | 61 | 6 | 67 |
2018 January | 50 | 5 | 55 |
2017 December | 77 | 11 | 88 |
2017 November | 75 | 20 | 95 |
2017 October | 51 | 12 | 63 |
2017 September | 62 | 9 | 71 |
2017 August | 52 | 10 | 62 |
2017 July | 68 | 13 | 81 |
2017 June | 58 | 12 | 70 |
2017 May | 80 | 16 | 96 |
2017 April | 60 | 13 | 73 |
2017 March | 68 | 19 | 87 |
2017 February | 105 | 11 | 116 |
2017 January | 50 | 13 | 63 |
2016 December | 53 | 6 | 59 |
2016 November | 121 | 12 | 133 |
2016 October | 173 | 7 | 180 |
2016 September | 254 | 10 | 264 |
2016 August | 356 | 7 | 363 |
2016 July | 201 | 15 | 216 |
2016 June | 148 | 0 | 148 |
2016 May | 136 | 0 | 136 |
2016 April | 115 | 0 | 115 |
2016 March | 96 | 0 | 96 |
2016 February | 115 | 0 | 115 |
2016 January | 139 | 0 | 139 |
2015 December | 134 | 0 | 134 |
2015 November | 115 | 0 | 115 |
2015 October | 111 | 0 | 111 |
2015 September | 80 | 0 | 80 |
2015 August | 89 | 0 | 89 |
2015 July | 73 | 0 | 73 |
2015 June | 46 | 0 | 46 |
2015 May | 44 | 0 | 44 |
2015 April | 17 | 0 | 17 |