Caracterización de la situación problémica en un estudio psicosocial con pacientes con enfermedad renal crónica

Introducción: La enfermedad renal crónica es un problema de salud a nivel mundial, su manifestación más grave, la insuficiencia renal crónica, incide en el contexto cubano y determina el crecimiento de pacientes en hemodiálisis. El objetivo del texto es valorar los principales resultados del diagnóstico y caracterización de la situación problémica en un estudio de carácter psicosocial con pacientes con Insuficiencia Renal Crónica en la sala de Hemodiálisis del municipio Florida, de la provincia de Camagüey. Método: Es una investigación-acción participativa de corte experimental, que se desarrolla entre enero 2023 y diciembre del 2024 la cual constituye salida del proyecto de investigación Sistema de acciones psicosociales para el perfeccionamiento de la atención integral a los pacientes con enfermedades no transmisibles. El universo está constituido por 56 pacientes y la muestra por 22, que reciben tratamiento depurador y conservador, 22 familiares y 12 profesionales del servicio. El instrumento de investigación por excelencia fue la encuesta a participantes. Resultados: La edad de los pacientes no es definitiva de un grupo etario; predominan los hombres; se constata un elevado por ciento de pacientes con poca tolerancia a la adherencia al tratamiento e insuficiente desarrollo de las habilidades psicosociales y declaran la necesidad de poseer conocimientos para lograr estados de salud que conlleven a la sobrevida. Discusión: No existe coincidencia con lo constatado en la determinación de los grupos etarios de prevalencia para la enfermedad, pero los especialistas insisten en que la enfermedad no es privativa de un período de vida específico; reconocen la importancia del conocimiento de los factores de riesgo por el paciente para la prevención, promoción y educación en salud y resaltan la necesidad de la comunicación y la empatía entre el personal de salud y el paciente, para lograr resultados y estados emocionales favorables ante la enfermedad y el tratamiento.

Introduction: Chronic kidney disease is a global health problem. Its most serious manifestation, chronic kidney failure, affects the Cuban context and determines the growth of patients on hemodialysis. The objective of the text is to evaluate the main results of the diagnosis and characterization of the problematic situation in a psychosocial study with patients with Chronic Renal Failure in the Hemodialysis room of the Florida municipality, of the county of Camagüey. Method: It is an experimental participatory action research, which takes place between January 2023 and December 2024, which constitutes the output of the research project System of psychosocial actions for the improvement of comprehensive care for patients with non-communicable diseases. The universe is made up of 56 patients and the sample is made up of 22, who receive purifying and conservative treatment, 22 family members and 12 service professionals. The research instrument par excellence was the participant survey. Results: The age of the patients is not definitive of an age group; men predominate; A high percentage of patients are found to have low tolerance for adherence to treatment and insufficient development of psychosocial skills and declare the need to possess knowledge to achieve health states that lead to survival. Discussion: There is no coincidence with what was found in the determination of the prevalence age groups for the disease, but specialists insist that the disease is not exclusive to a specific period of life; recognize the importance of the patient's knowledge of risk factors for prevention, promotion and health education and highlight the need for communication and empathy between health personnel and the patient, to achieve favorable results and emotional states in the face of the disease and treatment.

Incremento del riesgo hemorrágico en pacientes con fibrilación auricular y enfermedad renal crónica en hemodiálisis tratados con anticoagulantes. Serie de cuatro centros / Increased risk of bleeding in patients with atrial fibrillation and chronic kidney disease on hemodialysis treated with anticoagulants. A four center series

Resumen Objetivo: El objetivo de este estudio fue estimar si el uso de anticoagulantes se asociaba con una diferencia en la frecuencia de trombosis de cualquier sitio, hemorragia mayor y mortalidad en adultos con coexistencia de ambas patologías. Método: Se realizó un estudio de cohorte retrospectivo en cuatro centros de alta complejidad. Se incluyeron mayores de 18 años con ERC en hemodiálisis y FA no valvular, con indicación de anticoagulación (CHA2DS2VASc ≥ 2). El desenlace primario fue la ocurrencia de sangrado mayor, evento trombótico (accidente vascular cerebral, infarto agudo al miocardio o enfermedad tromboembólica venosa) o muerte. Se realizó ajuste por variables de confusión por regresión logística. Resultados: De los 158 pacientes incluidos, el 61% (n = 97) recibieron anticoagulante. El desenlace principal se encontró en el 84% de quienes recibieron anticoagulación y en el 70% de quienes no la recibieron (OR: 2.12, IC95%: 0.98-4.57; luego del ajuste OR: 2.13, IC95%: 1.04-4.36). De los desenlaces mayores se presentaron sangrado en el 52% vs. el 34% (OR: 2.03; IC95%: 1.05-3.93), trombosis en el 35% vs. el 34% (OR: 1.03; IC95%: 0.52-2.01) y muerte en el 46% vs. el 41% (OR: 1.25; IC95%: 0.65-2.38). Conclusiones: Los resultados de este estudio sugieren un incremento en el riesgo de sangrado en los pacientes con FA y ERC en hemodiálisis que reciben anticoagulación, sin disminución del riesgo de eventos trombóticos ni de muerte.

Abstract Objective: The aim of this study was to estimate whether the consumption of anticoagulants was associated with a difference in the frequency of thrombosis of any site, major bleeding and mortality, in adults with both diseases. Method: A retrospective cohort study was carried out in four high complexity centers. Patients older than 18 years with CKD on hemodialysis and non-valvular AF, with an indication for anticoagulation (CHA2DS2VASc ≥ 2), were included. The primary outcome was the occurrence of: major bleeding, thrombotic event (cerebrovascular accident, acute myocardial infarction or venous thromboembolic disease) or death. Adjustment for confounding variables was performed using logistic regression. Results: From 158 patients included, 61% (n = 97) received an anticoagulant. The main outcome was found in 84% of those who received anticoagulation and 70% of those who did not (OR: 2.12, 95%CI: 0.98-4.57; after the adjusted analysis OR: 2.13, 95%CI: 1.04-4.36). Separate outcomes were bleeding in 52% vs. 34% (OR: 2.03; 95%CI: 1.05-3.93), thrombosis in 35% vs. 34% (OR: 1.03; 95%CI: 0.52-2-01) and death in 46% vs. 41% (OR: 1.25; 95%CI: 0.65-2.38). Conclusions: The results of this study suggest an increased risk of bleeding in patients with AF and CKD on hemodialysis receiving anticoagulation, without a decrease in the risk of thrombotic events or all-cause mortality.

Accesibilidad, disponibilidad y asequibilidad de medicamentos para Niños con Enfermedad Renal Crónica en Guatemala / Access, availability and affordability of medications for children with Advanced Chronic Kidney Disease in Guatemala

El artículo tiene como objetivo analizar la disponibilidad, acceso y asequibilidad de los medicamentos para niños con Enfermedad Renal Crónica (ERC) en tratamiento con hemodiálisis (HD) en un país de bajos a medianos ingresos. Se llevó a cabo un estudio transversal para determinar los medicamentos más utilizados en una unidad de hemodiálisis pediátrica, incluyendo el nombre del medicamento, dosis, frecuencia, forma farmacéutica y vía de administración. Dos farmacias dentro del perímetro del hospital, una pública y una privada, fueron consultadas para determinar el costoy disponibilidad de medicamentos genéricos y de marca. De un total de 30 pacientes de la unidad de hemodiálisis, 22 expedientes fueron revisados. En general 94% de marca se encontraban disponibles en las farmacias consultadas en comparación a un 52% de los medicamentos genéricos. En farmacias públicas, 41% de medicamentos de marca y 29% de medicamentos genéricos se encontraban disponibles. El costo promedio para un mes de tratamiento con medicamentos de marca adquiridos en una farmacia privada era de $495.00 vs $299.00 en una farmacia pública. Para medicamentos genéricos, el costo promedio correspondía a $414.00 y $239.00 en farmacias privadas y públicas respectivamente. En promedio, los medicamentos de marca adquiridos en una farmacia privada requieren 41 días de trabajo en un mes a comparación de 25 días si se adquieren en una farmacia pública. Los medicamentos genéricos adquiridos en farmacias privadas corresponden a 34 días de trabajo vs 20 días en farmacias públicas. En general existió un acceso limitado a medicamentos genéricos y los medicamentos poseen un costo general más elevado a comparación de otros países lo que implica un posible impacto en la adherencia terapéutica y los padecimientos secundarios de la ERC en los pacientes pediátricos en Guatemala. Esta realidad se puede aplicar a otros países de bajos a medianos ingresos.

This article aims to analyze the availability, access, and affordability of medications for children with advanced Chronic Kidney Disease (CKD) treated with hemodialysis (HD) in a low to middle income country (LMIC). A cross- sectional chart review was carried out to determine the most common medications used in an HD pediatric unit, including medication name, dose, frequency, dosage form, and route of administration. Two pharmacies within the hospital perimeter, one public and one private, were consulted to determine medication cost and availability for generic and brand-name equivalents. From 30 patients attending the HD unit, 22 records were reviewed. Overall, 94 % of brand name medications were available at pharmacies consulted, versus and 52% of generic medications. In public pharmacies, 41% of brand name, and 29% of generic medications were available. The average cost for a full month´s treatment for brand name drugs in the private pharmacy was 495.00 USD versus 299.00 USD in the public pharmacy. For generic drugs, the average cost was 414.00 USD, and 239.00 USD in private and public pharmacies respectively. On average, brand-name drugs in the private pharmacy cost 41 days' wages versus 25 in the public pharmacy. Generic drugs in the private pharmacy cost 34 days' wages versus 20 in the public pharmacy. Overall, there was limited access to generic medications, medications had an overall high cost compared to other countries both of which have the potential to impact treatment adherence and overall outcomes of CKD5 pediatric patients in Guatemala. This reality can be translated to other LMIC.

Lipectomia como alternativa de superficialização de fístula arteriovenosa autóloga em pacientes obesos: a experiência de um centro de referência na Amazônia / Lipectomy as an alternative for superficialization of autologous AVF in obese patients: experience of a referral center in Amazon

Resumo Contexto O acesso vascular preferencial para hemodiálise é a fístula arteriovenosa nativa, pois oferece melhores resultados em curto e longo prazo, proporciona menor morbimortalidade e traz vantagens adicionais em relação aos cateteres venosos centrais ou enxertos arteriovenosos. No entanto, a obesidade pode oferecer um desafio adicional proporcionado pela barreira de tecido celular subcutâneo que recobre a superfície da veia a ser puncionada. Objetivos Demonstrar a experiência do serviço com a lipectomia em acessos autólogos em pacientes obesos. Métodos Foram revisados ​​pacientes consecutivos submetidos à lipectomia por impossibilidade ou dificuldade na punção da FAV, motivada pela acentuada profundidade da veia cefálica no antebraço ou braço. Resultados Vinte e dois pacientes foram revisados (15 homens e 7 mulheres), com índice de massa corporal médio de 34 kg/m2 (variação de 28 a 40 kg/m2). A idade média foi de 58,4 anos. O tempo médio entre a confecção do acesso e a lipectomia foi de 45,1 dias, e o tempo da intervenção até a liberação para uso nas sessões de hemodiálise oscilou de 21 a 42 dias, com média de 30,9 dias. A profundidade média pré-operatória da veia cefálica no membro foi de 7,9 mm (variação de 7,0 a 10,0 mm). Isso foi reduzido para uma profundidade média de 4,7 mm (faixa de 3,0 a 6,0 mm) (P = 0,01). O período médio de seguimento dos pacientes foi de 13,2 meses. Houve perda de seguimento em quatro pacientes e quatro óbitos no período não relacionados ao acesso vascular. Conclusões A obesidade não deve ser um fator limitante para a criação de uma FAV nativa, pois a lipectomia é uma alternativa relativamente simples de superficialização, que permite a funcionalidade de fístulas arteriovenosas nativas e profundas em obesos.

Abstract Background The preferred vascular access for hemodialysis is a native arteriovenous fistula (AVF) because it offers the best results in the short and long terms, lower morbidity and mortality, and has additional advantages in relation to central venous catheters or arteriovenous grafts. However, obesity can present an additional challenge because of the barrier of subcutaneous cellular tissue covering the surface of the vein to be punctured. Objectives The authors review their experience with excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients. Methods Consecutive vascular access patients undergoing lipectomy for cannulation with difficult access because of vein depth were reviewed. Cephalic vein depth was measured by ultrasound in all cases. Results Twenty-two patients were reviewed (15 men and 7 women), with a mean body mass index of 34.0 kg/m2 (range: 28-40 kg/m2). Mean age was 58.4 years. The mean preoperative vein depth of 7.9 mm (range: 7.0-10.0 mm) was reduced to 4.7 mm (range: 3.0-6.0 mm) (P 0.01). The mean follow-up period for patients was 13.2 months. Four patients were lost to follow-up and four died during the period due to causes unrelated to vascular access. Conclusions Obesity should not be a limiting factor to creation of a native AVF, since lipectomy is a relatively simple option for superficialization, enabling functioning native and deep arteriovenous fistulas in obese patients.

Dietary total antioxidant capacity, cardiovascular risk, and anthropometric obesity indices in hemodialysis patients: A case-control study / Capacidade antioxidante total da dieta, risco cardiovascular e índices antropométricos de obesidade em pacientes em hemodiálise: um estudo de caso-controle

ABSTRACT Objective: Oxidative stress is triggered by malnutrition and antioxidant losses due to dialysis in hemodialysis patients and thus, oxidative stress increases the risk of mortality in patients with cardiovascular disease and obesity. The study aims to determine differences in cardiovascular risk scores and obesity indices between hemodialysis and control groups and to examine the relationship between the tertiles of dietary total antioxidant capacity with cardiovascular risk, and obesity in hemodialysis and control groups. Methods: This is a cross-sectional case-control study involving hemodialysis patients (n=46) and healthy individuals (n=46). Participants' general characteristics were obtained via a questionnaire, and the Framingham Risk Score was calculated. The dietary total antioxidant capacity was calculated using two methods based on a seven-day food record. Obesity indices, such as Basal Metabolism Index and Body Shape Index, were calculated using anthropometric measurements. Results: The mean age of the participants was 51.1±10.4 years. In the hemodialysis group, obesity indices including body weight, Basal Metabolism Index, waist circumference, fat mass index, and fat-free mass index were lower, while Framingham Risk Score values ​​were higher than the control group (p<0.05). Energy-adjusted dietary total antioksidant capacity values were lower ​​in hemodialysis group, and most patients were in the low tertiles of Trolox equivalent antioxidant capacity, total radical-trapping antioxidant parameter, ferric reducing-antioxidant power and vitamin C equivalent antioxidant capacity (p<0.05). Conclusion: Providing hemodialysis patients with a healthy diet can increase the dietary total antioxidant capacity, and potentially reduce cardiovascular risk, and obesity indices.

RESUMO Objetivo: O estresse oxidativo é desencadeado pela desnutrição e perdas de antioxidantes devido à diálise em pacientes em hemodiálise, portanto, o estresse oxidativo aumenta o risco de mortalidade em pacientes com doenças cardiovasculares e obesidade. O estudo visa determinar as diferenças nos escores de risco cardiovascular e índices de obesidade entre os grupos de hemodiálise e controle, bem como examinar a relação entre os tercis da capacidade antioxidante total da dieta e o risco cardiovascular e obesidade nos grupos de hemodiálise e controle. Métodos: Este é um estudo transversal de caso-controle envolvendo pacientes em hemodiálise (n=46) e indivíduos saudáveis (n=46). As características gerais dos participantes foram obtidas por meio de um questionário, e o Escore de Risco de Framingham foi calculado. A capacidade antioxidante total da dieta foi calculada utilizando dois métodos baseados em um registro alimentar de sete dias. Índices de obesidade como o Índice de Metabolismo Basal e o Índice de Forma Corporal, foram calculados por meio de medidas antropométricas. Resultados: A média de idade dos participantes foi de 51.1±10.4 anos. No grupo de hemodiálise, os índices de obesidade, incluindo peso corporal, Índice de Metabolismo Basal, circunferência da cintura, índice de massa gorda e índice de massa livre de gordura, foram menores, enquanto os valores do Escore de Risco de Framingham foram maiores do que no grupo controle (p<0.05). Os valores de dTAC ajustados pela energia foram menores no grupo de foram hemodiálise, e a maioria dos pacientes estava nos tercis mais baixos de Capacidade antioxidante equivalente ao Trolox, parâmetro antioxidante total de captura de radicais, poder antioxidante redutor férrico e capacidade antioxidante equivalente à vitamina C (p <0.05). Conclusão: Fornecer aos pacientes em hemodiálise uma dieta saudável pode aumentar a capacidade antioxidante total da dieta, reduzindo potencialmente o risco cardiovascular e os índices de obesidade.

Awareness of stroke among patients with chronic kidney disease on hemodialysis: a cross-sectional study

ABSTRACT BACKGROUND: Stroke is a major cause of mortality worldwide. Renal dysfunction is an important risk factor for stroke. Brazilian studies on stroke knowledge are generally population based. Studies stratifying stroke knowledge according to comorbidities are rare. Scientific data are essential to guide the awareness of stroke. OBJECTIVE: To assess stroke knowledge in patients with chronic kidney disease (CKD) on hemodialysis. DESIGN AND SETTING: Cross-sectional analytical study of patients with CKD on hemodialysis in north-eastern Brazil. METHODS: A self-administered questionnaire survey on stroke awareness was administered to patients with CKD on hemodialysis between April and November 2022. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression. RESULTS: A total of 197 patients were included in the analysis. The Brazilian acronym for stroke was used by 53.5% of the participants. Less than 10.0% of the sample showed optimal decision-making ability regarding stroke. Of the participants, 29.9% knew at least one risk factor and one symptom; however, this was considered as having below the minimum capacity because they did not know the emergency service call number. In the analysis adjusted for income and education, females (odds ratio [OR], 0.40%; 95% confidence interval [CI], 0.20-0.82), older patients (OR, 0.24%; 95% CI, 0.09-0.63) and having at most one comorbidity (OR, 0.48%; 95% CI, 0.23-0.98) were factors for lower levels of knowledge or ideal decision-making capacity against stroke. CONCLUSIONS: Patients on hemodialysis, especially women and older people, have little knowledge about stroke.

Effects of roxadustat versus recombination human erythropoietin on coronary artery calcification in maintenance hemodialysis patients / 中国药房

OBJECTIVE To compare the effects of roxadustat and recombination human erythropoietin （rHuEPO） on coronary artery calcification in maintenance hemodialysis （MHD） patients. METHODS In retrospective analysis， MHD patients prescribed roxadustat in the Blood Purification Center of the First Affiliated Hospital of Chongqing Medical University from April 2019 to June 2021 were selected as the ROX group （56 patients）， and MHD patients prescribed rHuEPO during the same period were selected as the EPO group （60 patients）， and follow-up observation was conducted for 12 months. The differences in laboratory index， coronary artery calcification score （CACS）， and cardiac ultrasound parameters before and after treatment as well as the occurrence of cardiac and cerebrovascular adverse events during follow-up period were compared between the two groups. RESULTS There was no statistical difference in CACS between the two groups before and after treatment （P＞0.05）； but the difference of CACS in the ROX group was significantly lower than the EPO group （P＜0.05）. There was no statistically significant difference in cardiac ultrasound parameters and laboratory indexes between the two groups before and after treatment （P＜0.05）. The incidence of apoplexy and myocardial infarction in the ROX group was lower than that in the EPO group （P＜0.05）， and there was no statistically significant difference in the incidence of hospitalization due to heart failure between the two groups （P＞0.05）. CONCLUSIONS Compared with rHuEPO， roxadustat may have a positive effect on delaying coronary artery calcification in MHD patients and may be beneficial in reducing the incidence of myocardial infarction and apoplexy in MHD patients.

Adenine phosphoribosyltransferase deficiency after kidney transplantation: a case report and literature review / 器官移植

Objective To summarize the diagnosis and treatment experience of adenine phosphoribosyltransferase deficiency after kidney transplantation. Methods Clinical data of 1 patient with adenine phosphoribosyltransferase deficiency after kidney transplantation were retrospectively analyzed. Clinical characteristics, diagnosis, treatment and prognosis of adenine phosphoribosyltransferase deficiency were summarized by literature review. Results Renal biopsy showed that salt crystallization was found in most renal tubule lumen and positive results were observed under polarized light microscopy. After allopurinol, hemodialysis and anti-crystallization treatment, the graft function was gradually recovered. After postoperative 1-year follow-up, the patient's renal function was properly recovered. Conclusions Adenine phosphoribosyltransferase deficiency after kidney transplantation may lead to delayed graft function or graft dysfunction. Early detection, diagnosis and treatment may delay disease progression and improve renal function.

Perfil sociodemográfico e laboratorial dos pacientes submetidos à hemodiálise em um centro de referência do Estado do Ceará / Sociodemographic and laboratory profile of patients undergoing hemodialysis in a reference center in the State of Ceará / Perfil sociodemográfico y de laboratorio de dos pacientes sometidos a hemodiálisis en un centro de referencia del Estado de Ceará

A Doença Renal Crônica (DRC) é uma importante redução da função renal que causa alterações no metabolismo dos indivíduos. Para acompanhar a progressão da DRC e prevenir possíveis complicações, foi realizada uma pesquisa para avaliar o perfil sociodemográfico, bioquímico e hematológico de pacientes com Insuficiência Renal Crônica (IRC) submetidos a hemodiálise. Esta pesquisa foi quantitativa, descritiva e transversal de caráter retrospectivo, realizada por meio da análise de dados secundários contidos nos prontuários dos pacientes. A coleta de dados ocorreu no Centro de Hemodiálise da cidade de Russas, no Ceará. A amostra foi constituída por 161 pacientes com DRC, sendo 63,35% do sexo masculino e 85,71% pardos, com uma idade média de 54,39 anos. Desses, 63,97% tinham entre 2 e 10 anos de tratamento e 57,76% possuíam ensino fundamental incompleto. 19,25% residiam em Russas. Resultados: Após a hemodiálise, os resultados mostraram 44 mg/dL de Ureia, 48,44% dos pacientes com valores normais. A hemoglobina e hematócrito médios foram 11,8 g/dL e 33,7%, respectivamente, sendo que 63,35% tiveram valores reduzidos. 85,10% dos pacientes tiveram contagem de plaquetas normal, 72,04% níveis adequados de ferro e albumina, 52,79% tiveram níveis elevados de ferritina, 23,61% redução de transferrina e níveis lipídicos satisfatórios. 79,50% apresentaram níveis séricos de potássio dentro da normalidade, 12,42% de fósforo acima do normal, 85,09% de cálcio dentro dos valores normais, 39,13% de PTHi normais e 86,33% de glicose dentro dos valores considerados normais. Com base nos resultados, concluiu-se que todos os pacientes em tratamento hemodialítico apresentam diversas alterações em decorrência da DRC e do próprio processo de tratamento. Portanto, a realização de exames para avaliar ou monitorar possíveis complicações da IRC é essencial para criar estratégias e intervenções mais eficazes, que melhorem a assistência prestada a esses pacientes e, consequentemente, da qualidade e expectativa de vida dos mesmos.

Chronic Kidney Disease (CKD) is an important reduction in kidney function that causes changes in the metabolism of individuals. To monitor the progression of CKD and prevent possible complications, a survey was carried out to assess the sociodemographic, biochemical and hematological profile of patients with Chronic Renal Failure (CRF) undergoing hemodialysis. This research was quantitative, descriptive and cross-sectional with a retrospective character, carried out through the analysis of secondary data contained in the patients' medical records. Data collection took place at the Hemodialysis Center in the city of Russas, Ceará. The sample consisted of 161 patients with CKD, 63.35% male and 85.71% brown, with an average age of 54.39 years. Of these, 63.97% had between 2 and 10 years of treatment and 57.76% had incomplete primary education. 19.25% resided in Russas. Results: After hemodialysis, the results showed 44 mg/dL of Urea, 48.44% of patients with normal values. Average hemoglobin and hematocrit were 11.8 g/dL and 33.7%, respectively, with 63.35% having reduced values. 85.10% of the patients had normal platelet counts, 72.04% had adequate levels of iron and albumin, 52.79% had high levels of ferritin, 23.61% had reduced transferrin and satisfactory lipid levels. 79.50% had serum levels of potassium within the normal range, 12.42% of phosphorus above normal, 85.09% of calcium within normal values, 39.13% of PTHi normal and 86.33% of glucose within the values considered normal. Based on the results, it was concluded that all patients on hemodialysis have several changes due to CKD and the treatment process itself. Therefore, carrying out tests to assess or monitor possible complications of CRF is essential to create more effective strategies and interventions that improve the care provided to these patients and, consequently, their quality and life expectancy.

La Enfermedad Renal Crónica (ERC) es una reducción importante de la función renal que provoca cambios en el metabolismo de los individuos. Para monitorizar la evolución de la ERC y prevenir posibles complicaciones, se realizó una encuesta para evaluar el perfil sociodemográfico, bioquímico y hematológico de los pacientes con Insuficiencia Renal Crónica (IRC) en hemodiálisis. Esta investigación fue cuantitativa, descriptiva y transversal con carácter retrospectivo, realizada a través del análisis de datos secundarios contenidos en las historias clínicas de los pacientes. La recolección de datos ocurrió en el Centro de Hemodiálisis de la ciudad de Russas, Ceará. La muestra estuvo constituida por 161 pacientes con ERC, 63,35% del sexo masculino y 85,71% pardos, con una edad media de 54,39 años. De estos, 63,97% tenían entre 2 y 10 años de tratamiento y 57,76% tenían primaria incompleta. El 19,25% residía en Russas. Resultados: Posterior a la hemodiálisis los resultados arrojaron 44 mg/dL de Urea, 48,44% de los pacientes con valores normales. La hemoglobina y el hematocrito medios fueron 11,8 g/dl y 33,7 %, respectivamente, con un 63,35 % con valores reducidos. El 85,10% de los pacientes presentaba plaquetas normales, el 72,04% presentaba niveles adecuados de hierro y albúmina, el 52,79% presentaba niveles elevados de ferritina, el 23,61% presentaba transferrina reducida y niveles satisfactorios de lípidos. El 79,50% presentaba niveles séricos de potasio dentro de la normalidad, el 12,42% de fósforo por encima de lo normal, el 85,09% de calcio dentro de los valores normales, el 39,13% de PTHi normal y el 86,33% de glucosa dentro de los valores considerados normales. Con base en los resultados, se concluyó que todos los pacientes en hemodiálisis tienen varios cambios debido a la ERC y al propio proceso de tratamiento. Por tanto, la realización de pruebas para evaluar o monitorizar las posibles complicaciones de la IRC es fundamental para crear estrategias e intervenciones más eficaces que mejoren la atención a estos pacientes y, en consecuencia, su calidad y esperanza de vida.

El efecto de la reflexología podal sobre la fatiga en pacientes en hemodiálisis: un estudio de metaanálisis / The effect of foot reflexology on fatigue in hemodialysis patients: a meta-analysis study / O efeito da reflexologia podal sobre a fadiga em pacientes em hemodiálise: um estudo de metanálise

Objetivo: analizar el efecto de la reflexología podal sobre la fatiga en pacientes en hemodiálisis, combinando los resultados de estudios independientes sobre este tema. Método: estudio de metaanálisis. Se realizó una búsqueda bibliográfica en siete bases de datos. La calidad metodológica de los estudios incluidos se evaluó mediante las herramientas propuestas por el Joanna Briggs Institute. Para el metaanálisis se utilizó el programa Comprehensive Meta-Analysis v3. Resultados: en el metaanálisis se incluyeron ocho estudios. El resultado de la diferencia de medias estandarizada del metaanálisis = 1,580 (Intervalo de Confianza de 95% = 1,075 - 2,085 p = 0,000). El resultado del análisis de subgrupos realizado sobre la base de la diferencia de medias estandarizada en el número de sesiones de reflexología podal = 1,478 (Intervalo de Confianza de 95% = 1,210 - 1,747, p = 0,000). Conclusión: se concluyó que la reflexología podal puede utilizarse para reducir la fatiga en pacientes en hemodiálisis. En los estudios investigados no se proporcionó información sobre los posibles efectos secundarios y negativos de la reflexología podal.

Objective: this meta-analysis study analyzed the effect of foot reflexology on fatigue in hemodialysis patients by combining the results of independent studies on this subject. Method: meta-analysis study. A literature search was conducted in seven databases. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Comprehensive Meta-Analysis v3 was used for meta-analysis. Results: eight studies were included in the meta-analysis. The result of the meta-analysis standardized mean difference = 1.580 (95% Confidence Interval = 1.075 - 2.085 p = 0.000). The result of the subgroup analysis performed based on the number of foot reflexology sessions standardized mean difference = 1,478 (95% Confidence Interval = 1,210 - 1,747, p = 0.000). Conclusion: it was concluded that foot reflexology can be used to reduce fatigue in hemodialysis patients. No information was provided in the investigated studies about the possible side effects and negative effects of foot reflexology.

Objetivo: analisar o efeito da reflexologia podal sobre a fadiga em pacientes em hemodiálise, combinando os resultados de estudos independentes sobre este assunto. Método: estudo de metanálise. Foi realizada uma pesquisa bibliográfica em sete bases de dados. A qualidade metodológica dos estudos incluídos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. Para a metanálise, foi utilizado o Comprehensive Meta-Analysis v3. Resultados: oito estudos foram incluídos na metanálise. O resultado da diferença média padronizada da metanálise = 1,580 (Intervalo de Confiança de 95% = 1,075 - 2,085 p = 0,000). O resultado da análise de subgrupo realizada com base na diferença média padronizada do número de sessões de reflexologia podal = 1,478 (Intervalo de Confiança de 95% = 1,210 - 1,747, p = 0,000). Conclusão: a reflexologia podal pode ser utilizada para reduzir a fadiga em pacientes em hemodiálise. Não foram fornecidas informações nos estudos investigados sobre os possíveis efeitos colaterais e negativos da reflexologia podal.

Análisis de los factores pronósticos de mortalidad en los pacientes con enfermedad renal crónica en hemodiálisis / Analysis of Mortality Prognostic Factors in Patients with chronic Kidney Disease on Hemodialysis

Introducción: La enfermedad renal crónica es una de las principales causas de mortalidad en todo el mundo. La estratificación del riesgo a través del análisis de factores pronósticos podría generar un cambio de paradigma. Objetivo: Analizar los factores pronósticos de mortalidad en los pacientes con enfermedad renal crónica en hemodiálisis. Métodos: Se realizó un estudio no experimental, longitudinal de cohorte retrospectivo en los pacientes con enfermedad renal crónica en hemodiálisis en el Hospital General Docente: Dr. Ernesto Guevara de la Serna durante el período del 1 de enero de 2017 al 31 de diciembre de 2021. En general, se analizaron los factores pronósticos de mortalidad mediante el análisis multivariado de regresión logística binaria y se determinó el porcentaje correcto de clasificación del modelo de regresión. Resultados: Se analizaron como variables pronosticas de mortalidad la enfermedad cardiovascular [B = 3,831; p = 0,000; Exp (B) = 46,118], Albúmina 17 mmol/L [B = 1,326; p = 0,027; Exp (B) = 3,767], glucemia < 4 mmol/L [B = 1,600; p = 0,015; Exp (B) = 4,955] y ganancia de peso interdialítica excesiva [B = 2,243; p = 0,001; Exp (B) = 9,420]. El porcentaje global de clasificación del modelo de regresión logística binaria fue de 89,5 por ciento. Conclusiones: Se analizó el modelo predictivo de regresión logística que presentó una buena precisión con los factores de pronósticos asociados a la mortalidad en los pacientes en hemodiálisis(AU)

Introduction: Chronic kidney disease is one of the main causes of mortality worldwide. Risk stratification through the analysis of prognostic factors could generate a paradigm shift. Objective: To analyze the prognostic factors of mortality in patients with chronic kidney disease on hemodialysis. Methods: A non-experimental, longitudinal retrospective cohort study was carried out on patients with chronic kidney disease on hemodialysis at Dr. Ernesto Guevara de la Serna General Teaching Hospital from January 2017 to December 31, 2021. The prognostic factors of mortality were analyzed using multivariate binary logistic regression analysis and the correct percentage of classification of the regression model was determined. Results: Prognostic variables of mortality were analyzed, such as cardiovascular disease [B = 3.831; p = 0.000; Exp (B) = 46.118], albumin 17 mmol/L [B = 1.326; p = 0.027; Exp (B) = 3.767], blood glucose < 4 mmol/L [B = 1.600; p = 0.015; Exp (B) = 4.955] and excessive interdialytic weight gain [B = 2.243; p = 0.001; Exp(B) = 9.420]. The overall classification percentage of the binary logistic regression model was 89.5percent. Conclusions: The logistic regression predictive model was analyzed, which showed good precision with the prognostic factors associated with mortality in hemodialysis patients(AU)

Pushing the Boundaries of Hemodialysis: Innovations in Membranes and Sorbents

ABSTRACT Membranes and sorbents play a crucial role in extracorporeal blood purification therapies, which aim to remove harmful molecules and toxins from the blood. Over the years, advancements in hemodialysis (HD) membranes and sorbents have significantly enhanced their safety and effectiveness. This review article will summarize the latest breakthroughs in the development and clinical application of HD membranes and sorbents. We will commence with a concise examination of the mechanisms involved in solute transport across membranes and sorbents. Subsequently, we will explore the evolutionary path of HD membranes, from early cellophane membranes to high-flux membranes, including the development of high-cut-off membranes and the emergence of medium- cut-off membranes. We will discuss each type of HD membrane's advantages and limitations, highlighting the most promising advancements in novel biomaterials and biocompatibility, technologies, research in membrane performance, and their clinical applications. Furthermore, we will delve into the evolution and progress of sorbent technology, tracing its historical development, outlining its key characteristics, examining the mechanism involved in the adsorption process, and exploring its clinical application. This review aims to underscore the growth and future landscape of HD membranes and sorbents in extracorporeal blood purification techniques.

Are Medium Cut-off Membranes the Future, or the Promising Reality for Chronic Hemodialysis Patients?

ABSTRACT The development of hemodialysis (HD) membranes has substantially advanced in the last decade. This has resulted in the manufacturing of medium cut-off membranes (MCO) whose internal architecture is based on greater pore size and a smaller diameter, thus promoting the clearance of particles of greater size as well as retrofiltration. Multiple studies have proven their efficacy in the clearance of uremic mid-sized molecules such as β2-microglobulin, free light chains, and some interleukins; this clearance is far superior with MCO membranes when compared with high-flux HD, and similar to that obtained with online hemodiafiltration. This review summarizes the results of the most relevant clinical studies of this membrane in terms of uremic toxin clearance, as well as the features of some clinical outcomes such as quality of life and hospitalizations.

Advances in Hemodialysis in the Last Decade in Latin America

ABSTRACT Kidney replacement therapy (KRT) initiated in Latin America towards the second half of the 20th century, starting with dialytic therapies and, shortly thereafter, with kidney transplant. By the end of 2021, close to half a million Latin Americans were under KRT, with an overall unadjusted prevalence of 872 per million persons (pmp), yet with significant heterogeneity between nations. By treatment modality, 68% of prevalent patients were treated with hemodialysis (HD), 9% with peritoneal dialysis (PD), and 23% were living with a functioning kidney graft (LFG). In the last decade, HD is the KRT that has had the largest growth, and it also has incorporated newer and better technologies. Nevertheless, Latin America shows heterogeneity between countries, and as a region we are far from achieving full accessibility to all in need of KRT. While there has been growth and improvement in existing renal dialysis registries, and several countries that did not previously have these registries have implemented them, there are still some nations with limited or absent registry implementation. The number of nephrologists in the region is heterogeneous, with only four countries having an appropriate group of specialists. The remaining nations have an important need to expand nephrology training programs. SLANH is a major regional player in addressing these topics and supporting the expansion of appropriate nephrology programs to improve inequalities and patient care.

Is Generative Artificial Intelligence the Next Step Toward a Personalized Hemodialysis?

ABSTRACT Artificial intelligence (AI) generative models driven by the integration of AI and natural language processing technologies, such as OpenAI's chatbot generative pre-trained transformer large language model (LLM), are receiving much public attention and have the potential to transform personalized medicine. Dialysis patients are highly dependent on technology and their treatment generates a challenging large volume of data that has to be analyzed for knowledge extraction. We argue that, by integrating the data acquired from hemodialysis treatments with the powerful conversational capabilities of LLMs, nephrologists could personalize treatments adapted to patients' lifestyles and preferences. We also argue that this new conversational AI integrated with a personalized patient-computer interface will enhance patients' engagement and self-care by providing them with a more personalized experience. However, generative AI models require continuous and accurate updates of data, and expert supervision and must address potential biases and limitations. Dialysis patients can also benefit from other new emerging technologies such as Digital Twins with which patients' care can also be addressed from a personalized medicine perspective. In this paper, we will revise LLMs potential strengths in terms of their contribution to personalized medicine, and, in particular, their potential impact, and limitations in nephrology. Nephrologists' collaboration with AI academia and companies, to develop algorithms and models that are more transparent, understandable, and trustworthy, will be crucial for the next generation of dialysis patients. The combination of technology, patient-specific data, and AI should contribute to create a more personalized and interactive dialysis process, improving patients' quality of life.

Tiempo de tratamiento y calidad de vida en pacientes con enfermedad renal crónica / Time-to-treatment and quality of life in patients with chronic kidney disease

INTRODUCCIÓN: La duración del tratamiento de hemodiálisis en pacientes con enfermedad renal crónica puede impactar significativamente en su calidad de vida. Esto se debe a las exigencias que conlleva someterse a este procedimiento, ya que implica ajustes en las actividades cotidianas. OBJETIVO: Determinar la relación entre el tiempo de tratamiento y la calidad de vida en pacientes con enfermedad renal crónica en atención primaria. METODOLOGÍA: Estudio descriptivo correlacional, con una muestra de 103 pacientes con enfermedad renal crónica con tratamiento de hemodiálisis. La calidad de vida se midió a través del instrumento SF-36, se analizó en el paquete estadístico SPSS utilizando estadística descriptiva e inferencial. RESULTADOS: Se reportó una media de calidad de vida global de 56,78 (DE=18,24) de valores de 0 a 100, el 50,5% de los participantes tiene de 4 a 6 años con el tratamiento de hemodiálisis. Se demostró una correlación negativa y significativa entre el tiempo de tratamiento con el rol físico (rs = -0,218, p = 0,05). Así mismo, entre la edad del paciente con la calidad de vida global (rs = -0,393, p = 0,01), analizada a través de las dimensiones función física, rol físico, dolor corporal, vitalidad y salud mental. CONCLUSIÓN: La edad y el tiempo de tratamiento afectan la calidad de vida de pacientes con enfermedad renal en tratamiento de hemodiálisis. Se recomienda implementar en la atención primaria intervenciones de enfermería que involucren ambas variables para promover una mejora sustancial en la calidad de vida de los pacientes.

INTRODUCTION: The duration of hemodialysis treatment in patients with chronic kidney disease can significantly impact their quality of life. This is due to the demands of this procedure since it involves adjustments in daily activities. OBJECTIVE: To determine the relationship between treatment time and quality of life in primary health care patients with chronic kidney disease. METHODOLOGY: Descriptive correlational study with a sample of 103 patients with chronic kidney disease with hemodialysis treatment. The quality of life was measured through the SF-36 instrument and analyzed in the statistical package SPSS using descriptive and inferential statistics. RESULTS: A mean global quality of life of 56,78 (SD=18,24) with values from 0 to 100 was reported, and 50,5% of the participants had 4 to 6 years of hemodialysis treatment. A negative and significant correlation was demonstrated between treatment time and physical role (rs = -0,218, p = 0,05). Likewise, the patient's age and overall quality of life (rs = -0,393, p = 0,01) are analyzed through the dimensions of physical function, physical role, bodily pain, vitality, and mental health. CONCLUSION: Age and treatment time affect the quality of life of patients with kidney disease undergoing hemodialysis treatment. It is recommended to implement nursing interventions in primary health care that involve both variables to promote a substantial improvement in patients' quality of life.

Inteligencia emocional y calidad de vida en pacientes con insuficiencia renal crónica en hemodiálisis de un hospital de la ciudad del Cusco

Contexto: la investigación busca determinar la relación entre la inteligencia emocional y la calidad de vida en pacientes con insuficiencia renal crónica que reciben tratamiento de hemodiálisis de un hospital de la ciudad del Cusco, considerando el riesgo de la enfermedad para el logro de una mejor vida y los recursos existentes en la psicología de la salud. Metodología: el estudio se ubica en un nivel básico con un alcance correlacional y un diseño no experimental-transversal. Se incluyeron 96 pacientes diagnosticados con insuficiencia renal crónica que asistían a hemodiálisis y que fueron evaluados con el inventario emocional BarOn y el cuestionario KDQOL SF-36 para la calidad de vida. Los datos de identificación de los pacientes fueron obtenidos de las fichas de registro utilizadas, previo consentimiento informado de los evaluados. Posteriormente, para el análisis de datos descriptivos e inferenciales, se emplearon frecuencias y porcentajes; además de estadísticos de asociación, como el tau-b de Kendall, chi cuadrado y d de Somers. Resultados: la relación para inteligencia emocional y calidad de vida muestra un valor de p < 0,05, mediante la prueba de chi cuadrado; el estadístico tau-b de Kendall = 0,340 explica la dirección positiva de la relación e intensidad moderada de la asociación; el estadístico d de Somers = 0,339 ratifica que la inteligencia emocional en general mejora la calidad de vida de los pacientes en una intensidad media. También, se halló una relación significativa para cada una de las dimensiones de la inteligencia emocional con la calidad de vida. Conclusiones: existe relación directa entre inteligencia emocional y calidad de vida en pacientes con insuficiencia renal crónica en hemodiálisis.

Background: The research seeks to determine the relationship between emotional intelligence and quality of life in patients with chronic renal failure who receive hemodialysis treatment at a hospital in the city of Cusco, considering the risk of the disease for achieving a better life and the existing resources in health psychology. Methods: The study is located at a basic level, following a correlational scope and a non-experimental - cross-sectional design. 96 patients diagnosed with chronic renal failure attending hemodialysis were included, who were evaluated with the BarOn Emotional Inventory and the KDQOL SF-36 questionnaire for quality of life. The identification data of the patients were obtained from the registration forms used, with the prior informed consent of those evaluated. Subsequently, for the analysis of descriptive and inferential data, frequencies and percentages were used, in addition to association statistics such as Kendall's Tau-b, Chi square and Somers' D. Results: The relationship for emotional intelligence and quality of life shows a value of p < 0.05, using the Chi-square test, the Kendall Tau-b statistic = 0.340, explains the positive direction of the relationship and moderate intensity of the association. , Somers' D statistic=0.339 confirms that emotional intelligence in general improves the quality of life of patients at a medium intensity. A significant relationship was also found for each of the dimensions of emotional intelligence with quality of life. Conclusions: There is a direct relationship between emotional intelligence and quality of life in patients with chronic renal failure on hemodialysis.

Relación entre hormona paratiroidea alterada y fracturas óseas en pacientes en hemodiálisis

Contexto: Las fracturas óseas en pacientes en hemodiálisis son frecuentes y agregan una grave incapacidad y morbimortalidad; se han relacionado a alteraciones óseo-minerales, aunque su asociación con las alteraciones de la hormona paratiroidea es controversial. Objetivo: determinar la relación entre hormona paratiroidea intacta (PTH) alterada y fracturas óseas en pacientes en hemodiálisis. Metodología: se realizó un estudio transversal y analítico en 250 pacientes en hemodiálisis atendidos en el Hospital Víctor Lazarte Echegaray (La Libertad, Perú) entre el 2015 y el 2020. Los pacientes se clasificaron de acuerdo con su valor de PTH (alterada si PTH 300 pg/ml) y la presentación de fracturas óseas. La asociación entre PTH alterada y la presencia de fracturas óseas se determinó al usar un análisis bivariado y multivariado; los resultados se presentan como odds ratio (OR) considerando un valor p significativo si < 0,05. Resultados: se evaluaron 250 pacientes, 69 tuvieron PTH alterada (27,6 %) y 181 tuvieron PTH normal (72,4 %); asimismo, 42 tenían fracturas óseas (16,8 %) y 208 no tenían fracturas óseas (83,2 %). De los 42 pacientes con fracturas óseas, 22 presentaron PTH alterada (52,4 %) y 20 PTH normal (47,6 %); de los 208 pacientes sin fracturas óseas, 47 presentaron PTH alterada (22,6 %) y 161 PTH normal (p = 0,001) (77,4 %). Así, tener PTH alterada se asoció a la presencia de fracturas óseas con un OR de 3,77 (IC 95 %: 1,90-7,49) en el análisis bivariado y un OR de 2,85 (IC 95 %: 1,19-6,82) en el análisis multivariado. Las covariables que se asociaron a presencia de fracturas óseas fueron: tener más de 60 años (OR: 2,74, IC 95 %: 1,12-6,69) y tener más de cinco años en hemodiálisis (OR: 6,72, IC 95 %: 2,98-15,13). Conclusiones: la hormona paratiroidea alterada se relaciona con fracturas óseas en pacientes en hemodiálisis.

Background: Bone fractures in patients on dialysis are frequent and impose a high burden of disability and multimorbidity. They have been linked to mineral-bone disorders but its association with parathyroid hormone remains controversial. Purpose: To determine the relationship between altered parathyroid hormone (PTH) and bone fractures in hemodialysis patients. Metthodology: A cross-sectional, analytical study was conducted in 250 hemodialysis patients attending Hospital Víctor Lazarte Echegaray from 2015 to 2020. Patients were classified according to whether their PTH was altered (PTH 300 pg/ml) and whether bone fractures were present. The association between altered PTH and the presence of bone fractures was determined using bivariate and multivariate analysis; the results are presented as odds ratio (OR) considering a significant p-value if <0.05. Results: 250 patients were evaluated in which 69 (27.6%) had altered PTH, 181 (72.4%) had normal PTH; likewise, 42 (16.8%) had bone fractures and 208 (83.2%) had no bone fractures. Of the 42 patients with bone fractures, 22 (52.4%) had altered PTH and 20 (47.6%) had normal PTH; of the 208 patients without bone fractures, 47 (22.6%) had altered PTH and 161 (77.4%) had normal PTH (p=0.001). Altered PTH was associated with the presence of bone fractures with OR: 3.77 (95% CI: 1.90-7.49) in the bivariate analysis and with OR: 2.85 (95% CI: 1.19-6.82) in the multivariate analysis. The covariates that were associated with the presence of bone fractures were being over 60 years (OR: 2.74, 95% CI: 1.12-6.69) and having been on hemodialysis for more than 5 years (OR: 6.72, 95% CI: 2.98-15.13). Conclusions: Altered parathyroid hormone is related with bone fractures in hemodialysis patients.

Need for hemodialysis in patients undergoing hematopoietic stem cell transplantation: risk factors and survival in a retrospective cohort

ABSTRACT Introduction: Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT) patients are exposed to acute and chronic nephrotoxic events (drugs, hypotension, infections, and microangiopathy). The need for hemodialysis (HD) may be associated with high mortality rates. However, the risk factors and clinical impact of HD are poorly understood. Aim: To analyze survival and risk factors associated with HD in allo-HSCT Patients and methods: single-center cohort study 185 (34 HD cases versus 151 controls) consecutive adult allo-HSCT patients from 2007-2019. We performed univariate statistical analysis, then logistic regression and competing risk regression were used to multivariate analysis. Survival was analyzed by Kaplan-Meier and Cox proportional-hazards models. Results: The one-year HD cumulative incidence was 17.6%. Univariate analysis revealed that HD was significantly associated with male gender, age (p 0.056), haploidentical donor, grade II-IV acute GVHD, polymyxin B, amikacin, cidofovir, microangiopathy, septic shock (norepinephrine use) and steroid exposure. The median days of glycopeptides exposure (teicoplanin/vancomycin) was 16 (HD) versus 10 (no HD) (p 0.088). In multivariate analysis, we found: norepinephrine (hazard ratio, HR:3.3; 95% confidence interval, 95%CI:1.2-8.9; p 0.024), cidofovir drug (HR:11.0; 95%CI:4.6 - 26.0; p < 0.001), haploidentical HSCT (HR:1.94; 95%CI:0.81-4.65; p 0.14) and Age (HR:1.01; 95%CI: 0.99-1.03; p 0.18). The HD group had higher mortality rate (HR:6.68; 95% CI: 4.1-10.9; p < 0.001). Conclusion: HD was associated with decreased survival in allo-HSCT. Carefully use of nephrotoxic drugs and improving immune reconstitution could reduce severe infections (shock) and patients requiring cidofovir, which taken together may result in lower rates of HD, therefore improving survival.

Competencia clínica del personal de enfermería para el manejo de la hipotensión arterial intradialítica en el servicio de hemodiálisis del Centro Médico Naval / Clinical competence of nursing staff for the management of intradialytic hypotension in the hemodialysis service of the Naval Medical Center

Introducción: el correcto manejo de la hipotensión arterial durante la hemodiálisis es fundamental en la formación y trabajo del personal de enfermería nefrológica del Centro Médico Naval. El personal debe tener conocimientos suficientes sobre la hipotensión y sus factores asociados que le ayuden a predecirla y actuar de manera preventiva, así como con habilidades instrumentales para llevar a cabo medidas en la práctica. Objetivo: analizar la competencia clínica del personal de enfermería en el servicio de hemodiálisis del Centro Médico Naval con respecto a su formación académica y experiencia profesional en el manejo de la hipotensión arterial intradialítica. Metodología: estudio prospectivo, descriptivo y observacional. Se emplearon dos instrumentos: una adaptación del Cuestionario de conocimientos para el manejo de hemodiálisis de Miller y la Guía de observación de habilidades instrumentales en el personal de enfermería de Murillo. Resultados: se contó con una muestra de doce enfermeros pertenecientes al servicio de hemodiálisis. El 33.3% mostró un nivel regular de competencia clínica y 66.7% un nivel bueno. En promedio, la competencia clínica se ubicó en 78%. Discusión: los resultados obtenidos difieren de los reportados en otras investigaciones, tanto por el año de aplicación como de los sujetos evaluados. Limitaciones: se contó con una muestra baja debido a que el personal del servicio no es numeroso. Conclusiones: es necesario reforzar los conocimientos del personal sobre el tema. Sin embargo, se observó que las habilidades instrumentales fueron excelentes en todos los casos. No se observa relación con el nivel de estudios o la experiencia profesional.

Introduction: the correct management of arterial hypotension during hemodialysis is fundamental in the training and work of the nephrological nursing staff at the Naval Medical Center. The staff must have sufficient knowledge about hypotension and its associated factors to help them predict it and act preventively, as well as instrumental skills to carry out measures in practice. Objective: to analyze the clinical competence of the nursing staff in the hemodialysis service of the Naval Medical Center concerning their academic training and profesional experience in the management of intradialytic arterial hypotension. Methodology: a prospective, descriptive, and observational study. Two instruments were used: an adaptation of Miller's Hemodialysis Management Knowledge Questionnaire and Murillo's Guide to Observation of Instrumental Skills in Nursing Personnel. Results: There was a sample of twelve nurses belonging to the hemodialysis service. 33.3% percent showed a fair level of clinical competence and 66.7% a good level. On average, clinical competence was 78%. Discussion: the results obtained differ from those reported in other studies, in terms of both the year of application and the subjects evaluated. Limitations: there was a low sample size due to the small number of service personnel. Conclusions: it is necessary to reinforce the knowledge of the personnel on the subject. However, it was observed that instrumental skills were excellent in all cases. No relationship was observed with the level of studies or professional experience.