RESUMEN

La hemodiálisis domiciliaria (HDD) con monitores de bajo flujo de líquido de diálisis ha ganado popularidad en los últimos años gracias a su sencillez de diseño, portabilidad y capacidad de desplazamiento. No obstante, existen dudas respecto a la adecuación que este tipo de técnica ofrece, pues utiliza monitores con baño a flujos bajos y lactato. El objetivo de este estudio fue demostrar los beneficios clínicos de la HDD con el monitor NxStage System One® introducido recientemente en España.Presentamos los resultados de un estudio observacional, retrospectivo que incluyó de manera no seleccionada a los primeros pacientes con HDD corta mediante este monitor en 12 centros en España. Se analizó la evolución clínica de 86 pacientes a 0, 6 y 12 meses, incluyendo datos relacionados con la prescripción, evolución de parámetros analíticos de dosis de diálisis, anemia, metabolismo óseo-mineral, evolución de la diuresis residual, utilización de fármacos y datos relacionados con permanencia en la técnica, y causas de salida a lo largo del seguimiento. Pudimos demostrar que este monitor proporcionó una adecuada dosis de diálisis, con tasa óptima de ultrafiltración, con mejoría de los principales marcadores bioquímicos de adecuación en diálisis. El uso de esta técnica se asoció con una disminución de antihipertensivos, captores del fósforo y agentes eritropoyéticos, observándose, además, muy buenos resultados de supervivencia tanto del paciente como de la técnica. La sencillez de este monitor unida a sus buenos resultados clínicos debería facilitar el crecimiento y utilización de la HDD, tanto en pacientes incidentes como prevalentes. (AU)

Home hemodialysis (HHD) with low-flow dialysate devices has gained popularity in recent years due to its simple design, portability, and ability to provide greater freedom of movement for our patients. However, there are doubts about the adequacy that this technology offers, since it uses monitors with low-flow bath and lactate. The aim of this study was to demonstrate the clinical benefits of low-flow HHD with the NxStage System One® recently introduced in Spain. We present the results of an observational, retrospective cohort study that included the first patients who started short daily HHD with this device in 12 Spanish centers. We analyzed the evolution of 86 patients at 0, 6 and 12 months, including data related to prescription, and evolution of biochemical parameters related to dialysis dose, anemia, mineral-bone metabolism; evolution of residual renal function, medication usage, and causes of withdrawal during the followup. We were able to demonstrate that this NxStage System One® monitor, in patients with HHD, have provided an adequate dialysis dose, with optimal ultrafiltration rate, with improvement of main biochemical markers of dialysis adequacy. The usage of this technique was associated to a decrease of antihypertensive drugs, phosphate binders and erythropoietin agents, with very good results both patient and technique survival. The simplicity of the technique, together with its good clinical outcomes, should facilitate the growth and utilization of HHD, both in incident and prevalent patients. (AU)

Asunto(s)

RESUMEN

Home hemodialysis (HHD) with low-flow dialysate devices has gained popularity in recent years due to its simple design, portability, and ability to provide greater freedom of movement for our patients. However, there are doubts about the adequacy that this technology offers, since it uses monitors with low-flow bath and lactate. The aim of this study was to demonstrate the clinical benefits of low-flow HHD with the NxStage System One® recently introduced in Spain. We present the results of an observational, retrospective cohort study that included the first patients who started short daily HHD with this device in 12 Spanish centers. We analyzed the evolution of 86 patients at 0, 6 and 12 months, including data related to prescription, and evolution of biochemical parameters related to dialysis dose, anemia, mineral-bone metabolism; evolution of residual renal function, medication usage, and causes of withdrawal during the followup. We were able to demonstrate that this NxStage System One® monitor, in patients with HHD, have provided an adequate dialysis dose, with optimal ultrafiltration rate, with improvement of main biochemical markers of dialysis adequacy. The usage of this technique was associated to a decrease of antihypertensive drugs, phosphate binders and erythropoietin agents, with very good results both patient and technique survival. The simplicity of the technique, together with its good clinical outcomes, should facilitate the growth and utilization of HHD, both in incident and prevalent patients.

RESUMEN

The objective of this study was to investigate whether the improvement in survival seen in patients on kidney replacement therapy reflects the enhanced survival of the general population. Patient and general population statistics were obtained from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry and the World Health Organization databases, respectively. Relative survival models were composed to examine trends over time in all-cause and cause-specific excess mortality, stratified by age and modality of kidney replacement therapy, and adjusted for sex, primary kidney disease and country. In total, 280,075 adult patients started kidney replacement therapy between 2002 and 2015. The excess mortality risk in these patients decreased by 16% per five years (relative excess mortality risk (RER) 0.84; 95% confidence interval 0.83-0.84). This reflected a 14% risk reduction in dialysis patients (RER 0.86; 0.85-0.86), and a 16% increase in kidney transplant recipients (RER 1.16; 1.07-1.26). Patients on dialysis showed a decrease in excess mortality risk of 28% per five years for atheromatous cardiovascular disease as the cause of death (RER 0.72; 0.70-0.74), 10% for non-atheromatous cardiovascular disease (RER 0.90; 0.88-0.92) and 10% for infections (RER 0.90; 0.87-0.92). Kidney transplant recipients showed stable excess mortality risks for most causes of death, although it did worsen in some subgroups. Thus, the increase in survival in patients on kidney replacement therapy is not only due to enhanced survival in the general population, but also due to improved survival in the patient population, primarily in dialysis patients.

Asunto(s)

RESUMEN

Introducción: Al entrevistar a un paciente en la sala de hemodiálisis se producen muchas interferencias en la comunicación ya que simultáneamente atendemos a otros pacientes y se presentan complicaciones que tendremos que resolver de forma inmediata. Mediante la consulta de enfermería se pretende evitar esto, y darle el valor y tiempo que tienen las intervenciones enfermeras que son parte del tratamiento. Debemos asegurar que el paciente recibe instrucciones terapéuticas correctamente escritas, revisarlas y verificarlas con él para poder hacer un ajuste de niveles de comprensión, además de motivarlo y corresponsabilizarlo para lograr la adquisición de conductas implicadas en su autocuidado. Objetivo: Evaluar el efecto de la consulta de enfermería al paciente renal en hemodiálisis sobre el cumplimiento terapéutico. Material y Método: Estudio observacional longitudinal prospectivo de cohorte. Muestra de 42 pacientes en programa de hemodiálisis desde enero a junio 2014. Los pacientes seleccionados para la consulta son aquellos para los que la investigadora del estudio es enfermera referente y colaboradora (Grupo A). Se recogen datos de las diferentes variables revisando las historias clínicas y mediante la entrevista con el paciente y cuidador principal. Resultados: Encontramos diferencias significativas al comparar las variables estudiadas entre el Grupo A y Grupo B (resto pacientes) en cuanto al fósforo y cumplimiento farmacológico, pero no se encontraron en cuanto al potasio aunque la tendencia es a mejorar los niveles. Conclusiones: La consulta de enfermería mejora la adherencia terapéutica en dieta y medicación, relacionándose con un mayor tiempo de dedicación al tratamiento y mayor contacto con el cuidador principal (AU)

Introduction: When interviewing a patient in the hemodialysis room, there is a lot of interference in communication since we simultaneously attend to other patients and present complications that we should solve immediately. Nursing consultation is intended to avoid this and give the value and time that nurses have interventions, which are part of the treatment. We must ensure that the patient receives correctly written therapeutic instructions, check and verify them with him in order to adjust comprehension levels, motivate and co-responsibility for achieving the acquisition of behaviors involved in self-care. Objective: To evaluate the effect of the nursing consultation on the therapeutic compliance in the renal patient on hemodialysis. Material and Method: A prospective longitudinal observational cohort study. Sample of 42 patients in hemodialysis program from January to June 2014. Patients selected for the consultation are those that the researcher of the study is referring nurse and collaborator (Group A). Data are collected from the different variables by reviewing the medical records and by interviewing the patient and primary caregiver. Results: Significant differences were found when comparing the variables studied between Group A and Group B (rest patients) in terms of phosphorus and pharmacological compliance, but were not found in terms of potassium although the tendency is to improve levels. Conclusions: The nursing consultation improves the therapeutic adherence in diet and medication, being related to a greater time of dedication to the treatment and greater contact with the main caregiver (AU)

Asunto(s)

Asunto(s)

RESUMEN

No disponible

Asunto(s)

RESUMEN

No disponible

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)