RESUMEN
Background: Knowledge of one's own chronic kidney disease (CKD) can improve long-term quality of life (QoL). Peritoneal dialysis presents with residual symptoms that reduce the QoL. Objective: To correlate knowledge of the disease and QoL in patients with CKD and on continuous ambulatory peritoneal dialysis (CAPD). Material and methods: A descriptive, cross-sectional, and prospective study was carried out in patients with CKD treated at a second-level hospital of the Mexican Institute for Social Security (Instituto Mexicano del Seguro Social) in Puebla. SF-36 and KiKS questionnaires were applied. Age, sex, education, marital status, perception of QoL, and level of knowledge were recorded. Descriptive statistics and Spearman's coefficient were used. Results: 199 patients with CKD in CAPD were included, 62.8% women, minimum age range was 18 to 20 years with 4% and maximum of 61 years or more with 49.2%, 35.6% of patients completed primary school, and 65.3% were married. The most frequent comorbidity was diabetes (57.2%). The least affected QoL domain was pain. KiKS recorded a mean of 0.54 (regular knowledge about the disease). It was recorded a weak and significant correlation in the QoL domains: physical health, physical role, pain, general health, mental health (p ≤ 0.05). Conclusions: There is a significant but weak correlation between the perception of QoL and the level of knowledge of the disease in CKD patients with CAPD.
Introducción: el conocimiento adecuado de la enfermedad renal crónica (ERC) puede mejorar la calidad de vida (CV) a largo plazo. La diálisis peritoneal cursa con síntomas residuales que reducen la CV. Objetivo: correlacionar el conocimiento de la enfermedad y la CV en pacientes con ERC y en diálisis peritoneal continua ambulatoria (DPCA). Material y métodos: se llevó a cabo un estudio descriptivo, transversal y prospectivo en pacientes con ERC atendidos en un hospital de segundo nivel de atención del Instituto Mexicano del Seguro Social (IMSS) en Puebla. Se les aplicaron los cuestionarios SF-36 y KiKS. Se registró edad, sexo, escolaridad, estado civil, percepción de calidad de vida, nivel de conocimiento. Se utilizó estadística descriptiva y coeficiente de Spearman. Resultados: se incluyeron 199 pacientes con ERC en DPCA, 62.8% mujeres, edad mínima de 18 a 20 años (4%) y máxima 61 años o más (49.2%), 35.6% de los pacientes cursó primaria completa, y 65.3% estaban casados. La comorbilidad más frecuente fue diabetes (57.2%). El dominio de CV menos afectado fue el dolor. El KiKS registró una media de 0.54 (conocimiento regular sobre la enfermedad). Se registró una correlación débil y significativa en los dominios de CV: salud física, rol físico, dolor, salud general, salud mental (p ≤ 0.05). Conclusiones: existe una correlación significativa pero débil entre la percepción de la CV y el nivel de conocimiento de la enfermedad en los pacientes con ERC con DPCA.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Diálisis Peritoneal Ambulatoria Continua , Calidad de Vida , Insuficiencia Renal Crónica , Humanos , Femenino , Masculino , Estudios Transversales , Persona de Mediana Edad , Estudios Prospectivos , Adulto , Insuficiencia Renal Crónica/terapia , Insuficiencia Renal Crónica/psicología , Adulto Joven , Adolescente , Diálisis Peritoneal Ambulatoria Continua/psicología , México , Anciano , Encuestas y CuestionariosRESUMEN
Despite its rare frequency, a pleuroperitoneal communication is a well-documented complication for patients on peritoneal dialysis. It occurs in ~2% of continuous ambulatory peritoneal dialysis, with uncertain incidence for those on automated peritoneal dialysis. We report a case of a 30-year-old female patient with end-stage kidney disease with sudden dyspnea 2 days after starting automated peritoneal dialysis. Her chest x-ray revealed a significant pleural effusion on the right side. A thoracocentesis was performed, with a pleural glucose/plasma glucose of 1.08. Additionally, a computed tomography scan revealed a pleuroperitoneal communication upon dialysate infusion added with media contrast. A pleural-to-serum glucose gradient of greater than 50 mg/dL may indicate the diagnosis of a pleuroperitoneal communication in patients on peritoneal dialysis. Current literature also indicates that a pleural-to-serum glucose ratio above 1.0 may provide a more sensitive analysis. This case highlights the diagnosis process for this complication, with both laboratory and image findings corroborating the clinical hypotheses of a pleuroperitoneal communication in a patient on automated peritoneal dialysis.
Asunto(s)
Hidrotórax , Fallo Renal Crónico , Diálisis Peritoneal Ambulatoria Continua , Diálisis Peritoneal , Humanos , Femenino , Adulto , Hidrotórax/etiología , Diálisis Peritoneal/efectos adversos , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicaciones , GlucosaRESUMEN
Paracoccidioidomycosis is a systemic mycosis found mainly in South America and is the most prevalent endemic and systemic mycosis in Brazil. The purpose of this paper was to report the case of a male patient who developed peritonitis caused by Paracoccidioides spp. Forty-eight-year-old, male patient, with type I Diabetes mellitus and chronic kidney disease who was undergoing a Continuous Ambulatory Peritoneal Dialysis (CAPD) program. After eighteen months of peritoneal dialysis, the patient developed turbidity of the peritoneal fluid and was diagnosed with peritonitis. Direct mycological examination of the peritoneal fluid revealed yeasts with morphology suggestive of Paracoccidioides spp. The patient was treated with sulfamethoxazole-trimethoprim (1,600 mg/320 mg dose/day) for 61 days, but he died because a bacterial septic shock. The diagnosis of opportunistic PCM peritonitis was later confirmed by autopsy and Paracoccidioides spp. isolation. This is the first reported case of a patient on CAPD who experienced complications due peritonitis caused by opportunistic PCM.
Asunto(s)
Fallo Renal Crónico , Paracoccidioides , Diálisis Peritoneal Ambulatoria Continua , Peritonitis , Humanos , Masculino , Persona de Mediana Edad , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/diagnóstico , Peritonitis/microbiología , Líquido Ascítico/microbiología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , BrasilRESUMEN
Peritoneal dialysis (PD) modalities affect solute removal differently. However, the impacts of switching PD modalities on serum levels of biomarkers of different sizes are not known. Our objective was to analyze whether a change in the PD modality associates with the levels of two routine biochemical laboratories. In this multicentric prospective cohort study. we selected all patients who remained on a PD modality for at least 6 months and switched PD modality. Patients were also required to be treated with the same PD modality for at least 3 months before and after the modality change. The primary outcome was change in potassium and phosphate serum levels. We identified 737 eligible patients who switched their PD modality during the study. We found mean serum phosphate levels increased during the 3 months after switching from CAPD to APD and conversely decreased after switching to from APD to CAPD. In contrast, for potassium the difference in the mean serum levels was comparable between groups switching from CAPD to APD, and vice versa. In conclusion, CAPD seems to be as efficient as APD for the control of potassium serum levels, but more effective for the control of phosphate serum levels. The effect of a higher removal of middle size molecules as result of PD modalities in terms of clinical and patient-reported outcomes should be further explored.
Asunto(s)
Diálisis Peritoneal , Fosfatos/sangre , Potasio/sangre , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diálisis Peritoneal Ambulatoria Continua , Estudios ProspectivosRESUMEN
Introducción: la enfermedad renal crónica tiene consecuencias graves para los adultos mayores. La diálisis peritoneal continua ambulatoria es una alternativa de tratamiento, pero afecta la calidad de vida del paciente, la familia y el cuidador primario, por lo que se requiere un cuidador con habilidades que ofrezca apoyo en algunas actividades elementales y, además, apoye emocional y espiritualmente al paciente. Objetivo: identificar el nivel de la habilidad del cuidador primario del adulto mayor con diálisis peritoneal. Metodología: estudio descriptivo en 80 cuidadores familiares de adultos mayores con diálisis peritoneal continua ambulatoria. Se utilizó el instrumento Habilidad de cuidado del cuidador familiar, que consta de 55 reactivos y se divide en tres dimensiones: relación, 27 reactivos; comprensión, 18 reactivos; y modificación de la vida, 10 reactivos. El instrumento incluye variables sociodemográficas, de parentesco y tiempo dedicado al cuidado. Se elaboró una base de datos y éstos se analizaron mediante estadística descriptiva. Resultados: la habilidad de cuidado fue alta en 65%; la dimensión de relación resultó alta en 38.8% y media en 61.3%, con una comprensión alta en 86.2% y modificación de la vida alta en 68.8%. Los cuidadoras fueron mujeres en 85%; 46.3% cuidó > 37 meses; 50% cuidó > 24 h, y padres y esposa(o) apoyaron en 91.3%. Conclusión: estos hallazgos muestran que las habilidades de los cuidadores primarios fueron en general buenas, con la notoria participación del personal de enfermería en la capacitación y el apoyo recibido.
Introduction: Chronic kidney disease has severe consequences for older adults, and continuous ambulatory peritoneal dialysis is an alternative treatment, but it affects the quality of life of patient, family, and primary caregiver. It requires a caregiver with caregiving skills to provide support in some elemental activities, as well as emotional and spiritual support to the patient. Objective: To identify the level of caregiving skills of the primary caregiver of the older adult on peritoneal dialysis. Methodology: Descriptive study in 80 family caregivers of older adults with continuous ambulatory peritoneal dialysis. It was used the Caregiving skill of the family caregiver instrument, which consists of 55 items, divided into three dimensions: relationship, 27 items; understanding, 18 items; and life modification, 10 items. The instrument includes sociodemographic, relationship and time spent variables. A database was created and it was used descriptive statistics analysis. Results: Caregiving skills were high in 65%; relationship dimension high in 38.8%, and medium in 61.3%; understanding high in 86.2%; life modification high in 68.8%. 85% were female caregivers; 46.3% spent > 37 months providing care, 50% provided care > 24 hours; parents and wife/husband supported in 91.3%. Conclusion: Our findings show that caregiving skills of pri- mary caregivers were generally good with the significant involvement of the nursing staff in the training and support received.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Conocimientos, Actitudes y Práctica en Salud , Diálisis Peritoneal Ambulatoria Continua/enfermería , Cuidadores , Factores Socioeconómicos , Estudios Transversales , Cuidados a Largo PlazoRESUMEN
La enfermedad renal crónica es la vía final común de distintas patologías que afectan al parénquima renal. La prevalencia e incidencia de esta enfermedad se ha incrementado en las últimas décadas de forma exponencial, que la convierte en un grave problema de salud pública a nivel mundial, de acuerdo a su estadio requiere terapia de sustitución renal tipo diálisis peritoneal. La piel y sus anexos son afectados cuando existe un deterioro crónico de la función renal, algunas de las cuales influyen notoriamente en la calidad de vida de estos pacientes. Objetivo: identificar las manifestaciones en piel de los pacientes con enfermedad renal crónica, en diálisis peritoneal. Material y Métodos: estudio no experimental, transversal, descriptivo. Previo consentimiento informado, se evaluó a todos los 87 pacientes en diálisis peritoneal automatizada intermitente, de la sala de Nefrología del Hospital Escuela Universitario, de julio a diciembre del 2017. Se aplicó instrumento obteniendo datos generales, condición metabólica actual, tiempo en diálisis peritoneal y se realizó examen físico en búsqueda de manifestaciones dermatológicas por un dermatólogo, el día que asistieron a su sesión programada de diálisis. Se utilizó el programa estadístico Epi-Info versión 7.2. Resultados: todos los pacientes estudiados tenían al menos 2 manifestaciones dermatológicas, las de mayor frecuencia fueron: xerosis 72(82.8%), palidez 80(81.4%), alteraciones ungüeales 64(73.4%), prurito 56(64.4%), alteraciones pigmentarias 47(54%) y alteraciones en pelo 46(52.9%). Conclusión: la xerosis fuela manifestación más frecuente; no se encontró relación entre xerosis y prurito, ni entre prurito y niveles de azoados, calcio o fosforo. La principal manifestación en uñas fue onicopaquia y en pelo dermatitis seborreica.La incidencia de manifestaciones dermatológicas en pacientes con enfermedad renal crónica fue mayor a la de otros estudios, es importante identificar estos signos y síntomas para realizar diagnósticos tempranos y tratamientos oportunos...(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Manifestaciones Cutáneas , Insuficiencia Renal/diagnóstico , Diálisis Peritoneal Ambulatoria Continua , Tejido ParenquimatosoRESUMEN
Peritoneal dialysis (PD) is a renal replacement therapy based on infusing a sterile solution into the peritoneal cavity through a catheter and provides for the removal of solutes and water using the peritoneal membrane as the exchange surface. This solution, which is in close contact with the capillaries in the peritoneum, allows diffusion solute transport and osmotic ultrafiltration water loss since it is hyperosmolar to plasma due to the addition of osmotic agents (most commonly glucose). Infusion and drainage of the solution into the peritoneal cavity can be performed in two ways: manually (continuous ambulatory PD), in which the patient usually goes through four solution changes throughout the day, or machine-assisted PD (automated PD), in which dialysis is performed with the aid of a cycling machine that allows changes to be made overnight while the patient is sleeping. Prescription and follow-up of PD involve characterizing the type of peritoneal transport and assessing the offered dialysis dose (solute clearance) as well as diagnosing and treating possible method-related complications (infectious and non-infectious).
Asunto(s)
Fallo Renal Crónico/terapia , Diálisis Peritoneal/métodos , Antibacterianos/administración & dosificación , Antibacterianos/clasificación , Soluciones para Diálisis/uso terapéutico , Humanos , Diálisis Peritoneal Ambulatoria ContinuaRESUMEN
BACKGROUND: Peritoneal dialysis (PD) requires the support of a main caregiver, who can be subjected to an intense workload, and is susceptible to physical, psychological and social alterations. OBJECTIVE: To determine the prevalence of burden in primary informal caregivers of PD patients, the associated factors and their impact on patients at 12 months. MATERIAL AND MEHOTDS: 180 caregivers were included, with an average age of 42.8 ± 13.9 years, 73.3% were women. The Zarit survey was applied to assess the degree of caregiver overload. RESULTS: We identified that the majority of caregivers do not present overload; however, there is a greater burden in patients with continuous ambulatory PD (CAPD), with higher overall mortality in the group with severe burden (p < 0.05). Linear regression showed an association between hours of patient care, occupation, dialysis modality, and schooling with the presence of caregiver overload (p < 0.05). CONCLUSIONS: The burden presented by the caregiver is similar to that reported in the literature. CAPD patients whose family member has severe burden show higher global mortality at 12 months.
ANTECEDENTES: La diálisis peritoneal (DP) requiere el apoyo de un cuidador principal, quien puede verse sometido a una intensa carga de trabajo y es susceptible de presentar alteraciones físicas, psicológicas y sociales. OBJETIVO: Determinar la prevalencia de sobrecarga en cuidadores informales primarios de pacientes en DP, los factores asociados y su impacto en los pacientes a 12 meses. MATERIAL Y MÉTODOS: Se incluyeron 180 cuidadores, con una edad promedio de 42.8 ± 13.9 años, y el 73.3% eran mujeres. Se aplicó la encuesta Zarit para valorar el grado de sobrecarga del cuidador. RESULTADOS: Se identifica que la mayoría de los cuidadores no presenta sobrecarga; sin embargo, existe mayor sobrecarga en pacientes con DP continua ambulatoria (DPCA), con mayor mortalidad global en el grupo con sobrecarga intensa (p < 0.05). La regresión lineal mostró asociación entre las horas al cuidado del paciente, la ocupación, la modalidad de diálisis y la escolaridad con la presencia de sobrecarga del cuidador (p < 0.05). CONCLUSIONES: La sobrecarga que presenta el cuidador es similar a lo reportado en la literatura. Los pacientes en DPCA cuyo familiar tiene sobrecarga intensa presentan mayor mortalidad global a 12 meses.
Asunto(s)
Diálisis Peritoneal Ambulatoria Continua , Diálisis Peritoneal , Adulto , Cuidadores , Costo de Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Encuestas y CuestionariosRESUMEN
SUMMARY Peritoneal dialysis (PD) is a renal replacement therapy based on infusing a sterile solution into the peritoneal cavity through a catheter and provides for the removal of solutes and water using the peritoneal membrane as the exchange surface. This solution, which is in close contact with the capillaries in the peritoneum, allows diffusion solute transport and osmotic ultrafiltration water loss since it is hyperosmolar to plasma due to the addition of osmotic agents (most commonly glucose). Infusion and drainage of the solution into the peritoneal cavity can be performed in two ways: manually (continuous ambulatory PD), in which the patient usually goes through four solution changes throughout the day, or machine-assisted PD (automated PD), in which dialysis is performed with the aid of a cycling machine that allows changes to be made overnight while the patient is sleeping. Prescription and follow-up of PD involve characterizing the type of peritoneal transport and assessing the offered dialysis dose (solute clearance) as well as diagnosing and treating possible method-related complications (infectious and non-infectious).
RESUMO A diálise peritoneal (DP) é uma terapia renal substitutiva baseada na infusão de uma solução estéril na cavidade peritoneal através de um cateter, proporcionando a remoção de solutos e água usando a membrana peritoneal como superfície de troca. Essa solução, em contato com os capilares do peritônio, permite o transporte difuso de solutos e a perda de água por ultrafiltração osmótica, uma vez que é hiperosmolar ao plasma devido à adição de agentes osmóticos (normalmente, a glicose). A infusão e drenagem da solução dentro da cavidade peritoneal pode ser realizada de duas maneiras: manualmente (DP ambulatorial contínua), em que o paciente, geralmente, passa por quatro trocas de solução durante o dia, ou por DP mecânica (automatizada), em que a diálise é realizada com o auxílio de uma máquina de diálise que permite que as trocas sejam feitas durante a noite, enquanto o paciente está dormindo. A prescrição e o acompanhamento da DP envolvem a caracterização do tipo de transporte peritoneal e a avaliação da dose de diálise oferecida (depuração do soluto), bem como o diagnóstico e tratamento de possíveis complicações relacionadas ao método (infecciosas e não infecciosas).
Asunto(s)
Humanos , Diálisis Peritoneal/métodos , Fallo Renal Crónico/terapia , Soluciones para Diálisis/uso terapéutico , Diálisis Peritoneal Ambulatoria Continua , Antibacterianos/administración & dosificación , Antibacterianos/clasificaciónRESUMEN
Los síntomas gastrointestinales son comunes en pacientes con enfermedad renal crónica terminal (ERCT) y puede llegar a ser de un 77 a 79%, los síntomas prevalentes más comunes son estreñimiento, indigestión, dolor abdominal y pirosis. La escala de evaluación de síntomas gastrointestinales (GSRS) y el cuestionario de la calidad que vida de reflujo y dispepsia (QOLRAD), han sido desarrolladas para evaluar pacientes con dispepsia, las características psicométricas en los diferentes lenguajes son buenas con confiabilidad y validación aceptable. Materiales y Métodos: se realizó un estudio descriptivo, de tipo prospectivo de corte transversal en 64 pacientes que asisten a diálisis peritoneal continua ambulatoria (DPCA) del Hospital Nacional Rosales, se obtuvieron características clínicas de los pacientes como edad, sexo, comorbilidades asociadas, tiempo en diálisis peritoneal y de DPCA, y se evaluaron los cuestionarios GSRS y QOLRAD. Resultados: La frecuencia de síntomas gastrointestinales (GSRS >1) es de un 90.6%, la indigestión es el síntoma más frecuente con 79.7%, seguido de reflujo con un 64.7%, El QOLRAD mostró que el impacto sobre la calidad de vida es leve, donde se encontró la mayor prevalencia de síntomas fue vitalidad (36%) y en problemas con comida y bebida (29.8%). Discusión: La frecuencia de síntomas gastrointestinales medida por la escala de GSRS en pacientes en DPCA es alta, en comparación con la literatura internacional. La indigestión y reflujo son los síntomas predominantes en estos pacientes, en la escala QOLRAD hay afectación en la calidad de vida la cual es leve.
Asunto(s)
Signos y Síntomas Digestivos , Diálisis Peritoneal Ambulatoria Continua , Medicina InternaRESUMEN
A 42-year-old indigenous Maya man presented to a non-profit clinic in rural Guatemala with signs, symptoms and laboratory values consistent with uncontrolled diabetes. Despite appropriate treatment, approximately 18 months after presentation, he was found to have irreversible end-stage renal disease (ESRD) of uncertain aetiology. He was referred to the national public nephrology clinic and subsequently initiated home-based continuous ambulatory peritoneal dialysis. With primary care provided by the non-profit clinic, his clinical status improved on dialysis, but socioeconomic and psychological challenges persisted for the patient and his family. This case shows how care for people with ESRD in low- and middle-income countries requires scaling up renal replacement therapy and ensuring access to primary care, mental healthcare and social work services.
Asunto(s)
Accesibilidad a los Servicios de Salud/economía , Fallo Renal Crónico/terapia , Diálisis Peritoneal Ambulatoria Continua , Servicios de Salud Rural , Guatemala , Disparidades en Atención de Salud , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/psicología , Masculino , Persona de Mediana Edad , Calidad de VidaRESUMEN
This study aims to report the continuous ambulatory peritoneal dialysis (CAPD) in a chronic kidney disease (CKD) dog, not responsive to conservative therapy. The animal had high levels of urea, but after three cycles of dialysis, there were decreased levels of urea. Due to the advanced stage of chronic kidney disease, the animal died and the necropsy findings were consistent with sepsis. Further studies needed in Veterinary Medicine regarding the choice of catheters, indication and type of peritoneal dialysis in order to avoid complications and achieve better results.
Este estudo tem como objetivo relatar a utilização da diálise peritoneal ambulatorial contínua (DPAC) em um cão com doença renal crônica (DRC), não responsivo à terapia conservadora. O animal tinha altos níveis de ureia, mas após três ciclos de diálise, teve diminuição dos níveis de ureia. Devido à fase avançada de doença renal crônica, o animal foi a óbito e os achados de necropsia foram consistentes com sepse. A prática de diálise peritoneal é pouco comum na prática clínica. São necessários mais estudos na Medicina Veterinária em relação à escolha de cateteres, indicação e tipo de diálise peritoneal, a fim de evitar complicações e obter melhores resultados.
Este estudio tiene como objetivo informar de la diálisis peritoneal ambulatoria continua (DPAC) en un perro con enfermedad renal crónica (ERC), que no responde a la terapia conservadora. El animal tenía altos niveles de urea, pero después de tres ciclos de diálisis, había disminuido los niveles de urea. Debido a la etapa avanzada de la enfermedad renal crónica, el animal murió, los resultados de la autopsia fueron consistentes con sepsis. Se necesitan más estudios en Medicina Veterinaria en relación a la elección de los catéteres, rápido y tipo de diálisis peritoneal para evitar complicaciones y obtener mejores resultados.
Asunto(s)
Animales , Perros , Diálisis Peritoneal Ambulatoria Continua/veterinaria , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/veterinaria , Sepsis/veterinariaRESUMEN
This study aims to report the continuous ambulatory peritoneal dialysis (CAPD) in a chronic kidney disease (CKD) dog, not responsive to conservative therapy. The animal had high levels of urea, but after three cycles of dialysis, there were decreased levels of urea. Due to the advanced stage of chronic kidney disease, the animal died and the necropsy findings were consistent with sepsis. Further studies needed in Veterinary Medicine regarding the choice of catheters, indication and type of peritoneal dialysis in order to avoid complications and achieve better results.(AU)
Este estudo tem como objetivo relatar a utilização da diálise peritoneal ambulatorial contínua (DPAC) em um cão com doença renal crônica (DRC), não responsivo à terapia conservadora. O animal tinha altos níveis de ureia, mas após três ciclos de diálise, teve diminuição dos níveis de ureia. Devido à fase avançada de doença renal crônica, o animal foi a óbito e os achados de necropsia foram consistentes com sepse. A prática de diálise peritoneal é pouco comum na prática clínica. São necessários mais estudos na Medicina Veterinária em relação à escolha de cateteres, indicação e tipo de diálise peritoneal, a fim de evitar complicações e obter melhores resultados.(AU)
Este estudio tiene como objetivo informar de la diálisis peritoneal ambulatoria continua (DPAC) en un perro con enfermedad renal crónica (ERC), que no responde a la terapia conservadora. El animal tenía altos niveles de urea, pero después de tres ciclos de diálisis, había disminuido los niveles de urea. Debido a la etapa avanzada de la enfermedad renal crónica, el animal murió, los resultados de la autopsia fueron consistentes con sepsis. Se necesitan más estudios en Medicina Veterinaria en relación a la elección de los catéteres, rápido y tipo de diálisis peritoneal para evitar complicaciones y obtener mejores resultados.(AU)
Asunto(s)
Animales , Perros , Sepsis/veterinaria , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/veterinaria , Diálisis Peritoneal Ambulatoria Continua/veterinariaRESUMEN
Aging of the population and the increased prevalence of diseases such as diabetes and arterial hypertension result in an increasing need of dialysis treatment. Herein we describe a cohort of elderly patients on peritoneal dialysis (PD) and assess the influence of the modality on the long-term survival. Out of a multicenter prospective cohort of 2,144 BRAZPD PD incident patients during a period from December 2004 to October 2007, 762 elderly adults, defined as patients ≥65-year-old, were eligible for the study, 413 started on automated PD (APD) and 349 on continuous ambulatory PD (CAPD). Patients were followed until death, transfer to hemodialysis, recovery of renal function, loss to follow-up, or transplantation. Demographics and clinical data were evaluated at baseline and described as mean ± standard deviation, median, or percentage. Competing risk and time-dependent Cox analysis were performed, having dialysis modality APD] vs. CAPD as a dependent variable, as hazard ratio (HR) is not proportional throughout the therapy time. Mean age was 74.5 ± 6.8 years in APD, 74.6 ± 6.7 in CAPD, 50.8% females in APD, 54.4% in CAPD. The frequently observed comorbidities were diabetes (52.3% in APD and 47% in CAPD) and left ventricular hypertrophy (36.3% in APD and 46.1% in CAPD) whereas 93.6% presented Davies score ≥2. In Cox time-dependent analysis, HR did not show difference up to 18 months HR = 1.11, confidence interval (CI) = 0.85-1.46], but thereafter, APD modality revealed lower risk of mortality (HR = 0.25, CI = 0.0073-0.86), when compared with CAPD. After adjustment for the confounding factors, CAPD presented a higher risk of mortality (HR = 4.50, CI = 1.29-15.64). No differences in survival were observed up to 18 months of therapy; however, beyond 18 months, APD modality was a protection factor.
Asunto(s)
Enfermedades Renales/epidemiología , Enfermedades Renales/terapia , Diálisis Peritoneal , Factores de Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Comorbilidad , Femenino , Humanos , Incidencia , Enfermedades Renales/diagnóstico , Enfermedades Renales/mortalidad , Masculino , Diálisis Peritoneal/efectos adversos , Diálisis Peritoneal/mortalidad , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Diálisis Peritoneal Ambulatoria Continua/mortalidad , Estudios Prospectivos , Factores Protectores , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
ResumenIntroducción. El objetivo de esta investigación fue evaluar la calidad de vida relacionada con la salud (CVRS) en pacientes con diálisis peritoneal continua ambulatoria (DPCA), en tres unidades renales del eje cafetero de Colombia, en 2015.Método. La metodología de este trabajo está sustentada en un diseño descriptivo transversal. Participaron voluntariamente 185 personas del Programa de DPCA. Se aplicó encuesta y cuestionario SF-36, [Alfa de Cronbach >0,7] y análisis binominal y multinominal. En escalas de 0 a 100 puntos de peor a mejor CVRS, se calculó medias por dimensión. Se utilizó el software SPSS-v21.Resultados. Población con alta vulnerabilidad socioeconómica. Comorbilidad con hipertensión y diabetes.Percepción de mejor CVRS en dolor corporal (Me=87,2) y función social, (Me=76,8). Peor CVRS en Rol físico (Me=52,1) y Rol emocional (Me= 57,3). Sin diferencias por género, la CVRS empeora con la edad.Conclusión.El cuidado de pacientes con DPCA requiere más investigación por enfermería. Intervenciones y evaluaciones de seguimiento en autocuidado domiciliario y apoyo social en roles físico y emocional. Se deben controlar eventos precursores de ERC.
AbstractIntroduction.The objective of this research was to evaluate the quality of life related to health (HRQOL) in patients with Continuous Ambulatory Peritoneal Dialysis (CAPD), in three renal units of the Colombian coffee industry, in 2015.Method.The methodology of this work is based on a descriptive cross - sectional design. 185 volunteers from the DPCA Program participated voluntarily. A SF-36 questionnaire, [Cronbach's alpha> 0.7] and binominal and multinominal analysis were applied. In scales of 0 to 100 points from worse to better HRQoL, we calculated means by dimension. SPSS-v21 software was used.Results.Population with high socioeconomic vulnerability. Comorbidity with hypertension and diabetes.Perception of best HRQOL in Body pain (Me = 87.2) and Social function, (Me = 76.8). HRQL in Physical role (Me = 52.1) and Emotional role (Me = 57.3). Without gender differences, HRQL worsens with age.Conclusion.Caring for patients with CAPD requires more research per nursing. Interventions and follow-up evaluations in home self-care and social support in physical and emotional roles. ERC precursor events should be controlled.
ResumoIntrodução. A grande quantidade de pacientes atendidos nas consultas externas hospitalárias e conhecer a importância de suas opiniões sobre o atendimento recebido neste serviço motiva o desenvolvimento do presente estudo, o qual busca conhecer a opinião de um grupo de usuários sobre as consultas externas de três hospitais públicos da cidade de Madrid e identificar fatores que influem na satisfação global destas pessoas.Método. Realizou-se um estudo descritivo transversal no qual se entrevistaram a 150 usuários de consultas externas mediante um questionário auto-administrado, previamente validado que constava de 12 ítens, englobados em duas dimensões com uma escala tipo Likert de 1 a 10 em função ao grau de satisfação, dos quais se obteve resultados sociodemográficos e de tipo descritivo. Por outra parte, se realizou uma análise bivariante na que se detectaram diferenças significativas em función do sexo, do nível acadêmico, da nacionalidade e da idade.Resultados. Na análise descritiva do questionário merece atenção que a qualidade administrativa é valorada abaixo de 5 pontos, enquanto que para a clínica, a valoração é de 6 pontos aproximadamente, da que resulta uma valoração do questionário total um pouco superior a 5. O tempo de espera em consultas foi o ítem que obteve a valoração média mais baixa de todo o questionário, com algo mais de 3,5 sobre 10, enquanto que a mais alta foi a obtida para o ítem referido ao atendimento por parte do pessoal de enfermagem, com uma nota de quase 7.Conclusão.Pode-se afirmar que na amostra estudada somente existem dois fatores que se relacionam com o incremento da satisfação dos usuários nas consultas externas: sexo masculino e haver cursado estudos universitários.
Asunto(s)
Humanos , Factores Socioeconómicos , Diálisis Peritoneal Ambulatoria Continua/enfermería , Insuficiencia Renal Crónica/enfermería , Industria del Café , ColombiaAsunto(s)
Líquido Ascítico , Hernia Inguinal/etiología , Conducto Inguinal , Fallo Renal Crónico/terapia , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Hidrocele Testicular/etiología , Anciano , Hernia Inguinal/diagnóstico , Hernia Inguinal/cirugía , Herniorrafia , Humanos , Masculino , Hidrocele Testicular/diagnóstico , Hidrocele Testicular/cirugíaRESUMEN
BACKGROUND: Many controversies exist regarding the management of dialysis-requiring acute kidney injury (D-AKI). No clear evidence has shown that the choice of dialysis modality can change the survival rate or kidney function recovery of critically ill patients with D-AKI. METHODS: We conducted a retrospective study investigating patients (≥16 years old) admitted to an intensive care unit with D-AKI from 1999 to 2012. We analyzed D-AKI incidence, and outcomes, as well as the most commonly used dialysis modality over time. Outcomes were based on hospital mortality, renal function recovery (estimated glomerular filtration rate-eGFR), and the need for dialysis treatment at hospital discharge. RESULTS: In 1,493 patients with D-AKI, sepsis was the main cause of kidney injury (56.2%). The comparison between the three study periods, (1999-2003, 2004-2008, and 2009-2012) showed an increased in incidence of D-AKI (from 2.56 to 5.17%; p = 0.001), in the APACHE II score (from 20 to 26; p < 0.001), and in the use of continuous renal replacement therapy (CRRT) as initial dialysis modality choice (from 64.2 to 72.2%; p < 0.001). The mortality rate (53.9%) and dialysis dependence at hospital discharge (12.3%) remained unchanged over time. Individuals who recovered renal function (33.8%) showed that those who had initially undergone CRRT had a higher eGFR than those in the intermittent hemodialysis group (54.0 × 46.0 ml/min/1.73 m2, respectively; p = 0.014). In multivariate analysis, type of patient, sepsis-associated AKI and APACHE II score were associated to death. For each additional unit of the APACHE II score, the odds of death increased by 52%. The odds ratio of death for medical patients with sepsis-associated AKI was estimated to be 2.93 (1.81-4.75; p < 0.001). CONCLUSION: Our study showed that the incidence of D-AKI increased with illness severity, and the use of CRRT also increased over time. The improvement in renal outcomes observed in the CRRT group may be related to the better baseline kidney function, especially in the dialysis dependence patients at hospital discharge.