A Tato

Definición de procesos e indicadores para la gestión de accesos vasculares para hemodiálisis

Resumen Introduccion La prevalencia del tratamiento renal sustitutivo ha aumentado hasta 885 pacientes por millon de habitantes. Mas del 50% de estos pacientes necesitan hemodialisis (HD) con acceso vascular (AVH) permanente. En nuestro centro se organizo un grupo multidisciplinar para gestionar los procesos relacionados con el AVH. Objetivos Definicion y evaluacion de procesos para gestionar los AVH. Material y metodo Ambito: hospital de tercer nivel de la Comunidad de Madrid, referencia para 550.000 habitantes. Periodo de estudio: 2002-2004. Metodo: se constituyo un grupo de trabajo multidisplinario. Definicion y descripcion de los 3 procesos mas frecuentes. Se utilizaron flujogramas para representacion grafica. Se definieron criterios e indicadores de calidad, con monitorizacion prospectiva en la historia clinica electronica, diseno de protocolo quirurgico especifico y analisis retrospectivo. Resultados Comparacion de resultados con los de la literatura: Primer acceso vascular: porcentaje de pacientes con fistulas arteriovenosas (FAV) desarrollado al comenzar HD; porcentaje de pacientes prevalentes con AVH autologo/protesico/cateter. Mantenimiento del acceso: tasa de trombosis FAV autologa-protesica, porcentaje de AVH rescatadas tras trombosis, tasa de cateteres temporales. Gestion de recursos: porcentaje de intervenciones ambulatorias, tasa de ingresos relacionados con AVH. Conclusiones Los AVH son la fuente de morbilidad e ingresos hospitalarios principal de los pacientes con insuficiencia renal cronica en programas de HD. La gestion multidisciplinar ha permitido conseguir resultados por encima de los estandares descritos en la bibliografia. No parece que haya otros factores determinantes de estos resultados, ya que los procedimientos tecnicos realizados no difieren de los descritos en la bibliografia.

Anemia Development and Cardiovascular Risk Management in Nonanemic Stage 3 Chronic Kidney Disease

Background/Aim. There is little information on the development of anemia in the early stages of chronic kidney disease. The aim of this study was to analyze the onset of renal anemia in a cohort of initially nonanemic chronic kidney disease patients followed up in nephrology clinics. Methods. This epidemiological, prospective, three-year, multicenter study enrolled patients aged 18–78 years with stage 3 chronic kidney disease without anemia. Interim analysis was performed on the data collected during the first 12 months. Results. The study included 432 patients, average age 63.6 years (range 22–78 years, 70% male). The main etiologies of chronic kidney disease were glomerular (11.6%), interstitial (10.4%), vascular (29.4%), and diabetic (16.9%). The percentages of patients with comorbidities were 33.8% diabetes (2.5% type 1), 69% dyslipidemia, and 93% hypertension. During the first year, 12.4% of patients developed anemia. The chronic kidney disease progression rate was low: proteinuria was 0.46 ± 0.8 g/24 h at one year versus 0.67 ± 1.0 g/24 h at baseline. Diabetic patients showed a greater prevalence of previous cardiovascular events (50.0% vs. 24.5%) and worse control of some modifiable cardiovascular risk factors: smoking (13.4% vs. 8.6%), obesity (BMI > 30 kg/m2, 33.6% vs. 25.3%), target blood pressure (<130/80 mmHg, 21.0% vs. 27.9%), and proteinuria (0.8 ± 1.1 vs. 0.6 ± 0.9 g/day). Conclusions. After one year, 12.4% of patients developed anemia. Diabetic patients had a higher cardiovascular risk and limited blood pressure control. The overall control of cardiovascular risk was unsatisfactory.

Effect of balance Solution on the Peritoneal Membrane in Automated Peritoneal Dialysis

Interference of conventional peritoneal dialysis fluids (cPDFs) with peritoneal membrane cell functions may be attributed to the dialysis fluids low pH, high glucose concentration, and/or the presence of glucose degradation products (GDPs), the last of which leads to higher levels of advanced glycation end-products (AGEs). It has been suggested that the peritoneal membrane might be better preserved by using biocompatible solutions, including cancer antigetn 125 (CA125). This prospective, open-label, multicentre, randomized, controlled, cross-over phase IV study compared the in vivo biocompatibility of a neutral-pH, low-GDP peritoneal dialysis (PD) solution (balance) with a cPDF in automated PD (APD) patients. Our study revealed a significantly increased appearance rate and concentration of CA125 in the peritoneal effluent of APD patients treated with the neutral-pH, low-GDP solution balance versus a conventional PD solution.