Tratamento com diálise peritoneal: a prática do autocuidado no contexto familiar / Peritoneal dialysis treatment: self-care practice in the family context / Tratamiento con diálisis peritoneal: la práctica del autocuidado en el contexto familiar

Os objetivos do estudo foram identificar as dificuldades enfrentadas pelos clientes ao realizar a diálise peritoneal ambulatorial contínua (DPAC) no domicílio e analisar as soluções por eles adotadas para lidar com elas. Recorte de dissertação aprovada em 2010, sendo um estudo descritivo, qualitativo, que utilizou o método da Pesquisa Convergente-Assistencial, cujo cenário foi um hospital estadual do Rio de Janeiro. Realizaram-se três grupos de encontros com nove sujeitos. A técnica da entrevista semiestruturada originou temas que resultaram na categoria convivência com o tratamento - pontos dificulta dores na realização da DPAC no domicílio. Os participantes afirmaram que dificuldades do tratamento podem ser superadas mediante adaptação individual com auxílio da equipe de enfermagem, de redes de apoio e de familiares. Demonstrou-se a necessidade de que o modelo pedagógico utilizado para o processo educativo dos clientes seja repensado, intermediando os saberes científicos com os saberes populares.

The study objectives were to identify the difficulties faced by clients in performing continuous ambulatory peritoneal dialysis (CAPD) at home, and to analyze the solutions they encountered. Drawn from a dissertation approved in 2010, article reports a descriptive, qualitative study using the Convergent-Care Research method. With a state hospital in Rio de Janeiro as scenario, three groups of meetings were held with nine subjects. The semi-structured interview technique yielded themes that resulted in the category coexisting with the treatment – difficult points in carrying out CAPD at home. The participants noted that difficulties in the treatment can be overcome by individual adaptation with the help of nursing staff, support networks and family. It was demonstrated that the teaching model used for client education needs to be rethought soas to mediate between scientific knowledge and popular knowledge.

El objetivo del estudio consistió en identificar las dificultades enfrentadas por los clientes al realizar diálisis peritoneal continua ambulatoria (DPCA) en casa y analizar las soluciones adoptadas para hacerles frente. Parte de disertación aprobada en 2010, consistiendo en un estudio descriptivo y cualitativo que utiliza el método de Investigación Convergente Asistencial. En el escenario, un hospital del estado de Río de Janeiro, tuvieron lugar tres grupos de encuentros con nueve individuos. La técnica de entrevista semiestructurada originó temas resultaron en la categoría Convivencia con el tratamiento - puntos que dificultan la realización de la DPCA en casa. Los participantes señalar on que las dificultades del tratamiento se pueden superar mediante la adaptación individual con ayuda del personal de enfermería, de redes de apoyo y de la familia. Se ha demostrado la necesidad de que el modelo pedagógico utilizado para el proceso educacional de los clientes se a repensado, intermediando el conocimiento científico con los saberes populares.

Relapsing Peritonitis Caused by Bordetella bronchiseptica in Continuous Ambulatory Peritoneal Dialysis Patient: A Case Report

Bordetella (B) bronchiseptica is a common veterinary pathogen, but has rarely been implicated in human infections. Most patients with B. bronchiseptica infections are compromised clinically such as in patients with a malignancy, AIDS, malnutrition, or chronic renal failure. We experienced a case of relapsing peritonitis caused by B. bronchiseptica associated with continuous ambulatory peritoneal dialysis (CAPD). A 56-yr-old male, treated with CAPD due to end stage renal disease (ESRD), was admitted with complaints of abdominal pain and a turbid peritoneal dialysate. The culture of peritoneal dialysate identified B. bronchiseptica. The patient was treated with a combination of intraperitoneal antibiotics. There were two further episodes of relapsing peritonitis, although the organism was sensitive to the used antibiotics. Finally, the indwelling CAPD catheter was removed and the patient was started on hemodialysis. This is the first report of a B. bronchiseptica human infection in the Korean literature.

Agreements between Indirect Calorimetry and Prediction Equations of Resting Energy Expenditure in End-Stage Renal Disease Patients on Continuous Ambulatory Peritoneal Dialysis

PURPOSE: Equations are frequently used to estimate resting energy expenditure (REE) in a clinical setting. However, few studies have examined their accuracy in end-stage renal disease (ESRD) patients. PATIENTS AND METHODS: To investigate agreement between indirect calorimetry and several REE estimating equations in 38 ESRD patients on peritoneal dialysis, we performed indirect calorimetry and compared the results with REEs estimated using 5 equations [Harris-Benedict (HBE), Mifflin, WHO, Schofield, and Cunningham]. RESULTS: Measured REE was 1393.2 +/- 238.7kcal/day. There were no significant differences between measured and estimated REEs except Mifflin (1264.9 +/- 224.8kcal/day). Root mean square errors were smallest for HBE, followed by Schofield, Cunningham, and WHO, and largest for Mifflin (171.3, 171.9, 174.6, 175.3, and 224.6, respectively). In Bland-Altman plot, correlation coefficients between mean values and differences were significant for HBE (r=0.412, p=0.012) and tended to be significant for Cunningham (r=0.283, p=0.086). In DM patients and patients with overhydration, HBE showed significant underestimation when REE increased. CONCLUSION: In ESRD patients on continuous ambulatory peritoneal dialysis (CAPD), REE-estimating equations have no significant differences from indirect calorimetry, except Mifflin. However, HBE showed greater bias than others when REE was high.

The effect of angiotensin II receptor blocker on peritoneal membrane transports in continuous ambulatory peritoneal dialysis patients.

OBJECTIVE: The objective of this study was to examine the effects of angiotensin II receptor blocker (ARB), used as an antihypertensive medication, on peritoneal membrane transporters in continuous ambulatory peritoneal dialysis (CAPD) patients. MATERIAL AND METHOD: Prospective and cross-over experimental study of peritoneal membrane transporters was conducted in 7 CAPD patients with hypertension. All previous antihypertensive drugs had been replaced by candesartan at the dose of 8-16 mg/day to control blood pressure below 140/90 mmHg. Hydralazine, which has no effect on peritoneal membrane transports, was added if the target blood pressure was not achieved. All patients had received candesartan for 12 weeks, then, were retreated with the previous antihypertensive drugs for another 6-week period. The modified peritoneal function tests assessing peritoneal membrane transports were performed at 1) baseline, 2) 6 weeks, 3) 12 weeks following candesartan treatment, and 4) 6 weeks after candesartan withdrawal. RESULTS: The blood pressure target was achieved in all patients and was not different among the 4 periods. The albumin clearance and 4-hour albumin loss were significantly decreased following candesartan treatment (p < 0.05). Both values returned to the high baseline levels after 6 weeks of candesartan withdrawal. There were no significant changes in net ultrafiltration and various small and large solute transports. No adverse effects, including hyperkalemia or increased erythropoietin dosage, had been observed. CONCLUSION: In hypertensive CAPD patients, candesartan could provide nutritional benefit by attenuating peritoneal loss of albumin and provides an effective antihypertensive action. Furthermore, candesartan does not impair other solute transports and net ultrafiltration.

Effectiveness of oral route isosorbide 5-mononitrate on peritoneal solute and fluid transports in CAPD patients.

BACKGROUND: Addition of sodium nitroprusside (NaNTP), a nitric oxide (NO) donor to peritoneal solution could enlarge the effective peritoneal surface area and the peritoneal pore size. This would be leading to increased clearance of all solutes. Generalized clinical usage of NaNTP in CAPD patients however is not practical because it has a very short half-life and needs a specific route of administration. Organic nitrate, another NO donor, has a longer half-life and could be more easily absorbed via many routes. OBJECTIVE: The present study was conducted to determine the effect and mechanism of oral active nitrate (isosorbide 5-mononitrate: ISMN) on solute andfluid transports in stable CAPD patients. MATERIAL AND METHOD: A prospective randomized placebo control with a crossover study was performed in nine stable CAPD patients. In group I (n = 4), the treatment included 1) oral ISMN at the dose of 20 mg bid for 5 days 2) wash out period for 7 days, and 3) placebo for 5 days. In group 2 (n = 5), the treatment regimens were placebo, wash out, and ISMN periods. RESULTS: The MTACs of low molecular weight (LMW) solutes in the ISMN period were greater than the placebo period: median urea, 16.7 vs 13.8 ml/min; creatinine (Cr), 7.9 vs 6.9 ml/min; and urate, 6.1 vs 5.5 ml/min (p < 0.05 for all except MTAC of urea). Administration of ISMN could also enhance the clearances of high molecular weight (HMW) solute with a magnitude of increase as follows: 10% for beta2-microglobulin, 50% for albumin, and 15% for immunoglobulin G (p < 0.05 for all). However, the values of restrictive coefficient of LMW as well as HMW solutes of both groups were not different, indicating that the increased solute transports are not due to alteration in the peritoneal membrane permeability. Despite the increased peritoneal solute clearance, net ultrafiltration (UF) was unchanged after drug administration, 110 (ISMN group) vs 120 ml (placebo group), (NS). CONCLUSION: ISMN has a similar effect as NaNTP in enhancing peritoneal clearances of both LMW and HMW solutes. The effect of ISMN, however, is mediated only via expansion of peritoneal surface area without significant change in pore size. As such, administration of oral ISMN to stable CAPD patients would be practically beneficial in enhancing the achievement of target solute clearances suggested by NKF- DOQI Guidelines.

The Relation Between Hypoalbuminemia and Compliance and Intima-media Thickness of Carotid Artery in Continuous Ambulatory Peritoneal Dialysis Patients

The aim of this study was to identify the main factor affecting compliance and intima-media thickness of the elastic common carotid artery in continuous ambulatory peritoneal dialysis patients. Increased intima-media thickness and decreased arterial compliance are associated with elevated risk of cardiovascular disease. This study included 20 patients and 20 age- and sex- matched healthy control subjects. The compliance and intima-media thickness of the right common carotid artery within 1 cm to the bifurcation were measured three times using high-resolution B-mode echocardiography. Blood samples were obtained to measure levels of hemoglobin, phosphorus, total calcium, total CO2, serum albumin, C-reactive protein, serum total cholesterol, LDL- and HDL-cholesterol and triglycerides. We found that the compliance of common carotid artery was lower in the patient group than in the control group. In the patient group, the compliance of common carotid artery was positively correlated with serum albumin concentration, and intima-media thickness of common carotid artery was negatively correlated with serum albumin levels. Stepwise regression analysis showed that serum albumin concentration was independently related to the compliance of common carotid artery, suggesting hypoalbuminemia can independently give deleterious effects on the arterial wall in continuous ambulatory peritoneal dialysis patients.

Three years of cadaveric renal transplantation.

AIM: To study patient and graft outcome and donor characteristics in cadaveric renal transplantation. MATERIAL AND METHODS: Fifty nine patients (35 males and 24 females) who underwent cadaveric renal transplantation between Oct'95 and Nov'98 were analysed. The recovery of renal function was correlated with the type and duration of dialysis. The number of rejections, donor characteristics and patient and graft survival was studied. RESULTS: Fifty nine patients were followed for a mean period of 14.58 months (SD 10.73), their age ranged from 17 to 64 years. Ten patients had primary graft failure, out of which four died and six are on maintenance dialysis. Seven died of other causes. Twelve patients had been on CAPD and 47 were on haemodialysis. Recovery of renal function was earlier in the haemodialysis group (mean 19.29 days SD 16.97) than in the CAPD group (31.6 days SD 32.3 days). But the difference was not statistically significant (p=0.36). The age of the donors ranged from 2 to 72 years (mean 42.8, SD 17.3). Seventeen died of CVA, 16 died of head injury, and one died of sedative overdose. Dual kidney transplant was done in nine patients of whom five have adequate graft function. CONCLUSION: Follow up for a mean period of 14.58 months shows patient survival of 81.3% and graft survival 72.8% with no significant difference in recovery of renal function between CAPD and HD groups. Poor results are due to HLA mismatch leading to rejection. The majority of the deaths were related to septicaemia.

Evaluación longitudinal de la capacidad de transporte del peritoneo en diálisis peritoneal pediátrica / A longitudinal study of the peritoneal transport capacity in paediatric peritoneal dialysis

El paciente pediátrico en diálisis peritoneal debe ser periódicamente evaluado para adecuar el procedimiento. Objetivo: evaluar la evolución de los parámetros de adecuación dialítica en pacientes pediátricos urémicos en diálisis peritoneal crónica. Se estudiaron a 24 pacientes de la Unidad de Nefrología del Hospital Luis Calvo Mackenna, Universidad de Chile, ingresados al programa de diálisis peritoneal crónica entre enero 1995 y octubre 1999. Se evaluó la dosis de diálisis (Kt/V) peritoneal y residual, a los 3,6 y 12 meses de iniciado el procedimiento, y el test de equilibrio peritoneal (PET) en los mismos tiempos. Se midió el crecimiento a través del puntaje Z talla/edad al ingreso y a los 12 meses de diálisis. Resultados: el valor promedio del Kt/V peritoneal y residual fue de 1,77 (DE = 1,08) y 1,04 (DE = 0,66) al inicio del procedimiento, y a los 12 meses los valores fueron 2,34 (DE = 0,89) y 0,35 (DE = 0,37) respectivamente. El cambio en el Kt/V residual mostró un p < 0,05. El PET promedio de glucosa y creatinina hora 4 fue de 0,72 (DE = 0,16) y 0,31 (DE = 0,12) al inicio, variando a 0,73 (DE = 0,2) y 0,40 (DE = 0,19) a los 12 meses de evolución, sin significancia estadística. El crecimiento expresado como Z talla/edad mostró al inicio del estudio un valor de -1,86 (DE = 1,06) y a los 12 meses de -2,05 (DE = 0,9). En el grupo de pacientes que ingresaron antes de los 12 meses de vida el Z talla/edad inicial vs el control a 1 año después fue de -2,5 y -1,65 respectivamente. Conclusión: los resultados muestran una estabilidad de la membrana peritoneal a lo largo del período estudiado, una pérdida de talla progresiva durante la terapia, y un crecimiento positivo en el grupo que inició la diálisis antes de los 12 meses

Prueba de equilibrio peritoneal, análisis de 80 casos, en el Servicio de Nefrolología del Hospital Juárez de México de la Secretaría de Salud y Asistencia / Peritoneal equilibration test. Analysis of 80 cases in the nefrology service of the Hospital Juarez de Mexico, SSA

La prueba de equilibrio peritoneal (PET) fue descrita en 1987 por Z. Twardovsky, como una prueba para conocer la difusión de solutos y capacidad de ultrafiltración (UFR) en la membrana peritoneal (MP). La PET ha permitido clasificar el tipo de transporte peritoneal (TP), en los pacientes que se encuentran en diálisis peritoneal (DP) en: promedio alto, promedio bajo, alto y bajo. El presente trabajo tiene como objetivo, presentar el análisis prospectivo de 80 casos de PET, realizadas en el Servicio de Nefrología del hospital Juárez de México.Se incluyeron a 80 pacientes en DP, de ambos sexos, adultos, sin peritonitis, ni inestabilidad cardiovascular, que tuvieran por lo menos 6 meses en el programa de diálisis peritoneal continua ambulatoria (DPCA). Se les hizo PET en la unidad ambulatoria de diálisis del hospital. Después de hacer la PET. los resultados fueron: 35 pacientes como promedio alto, 15 promedio bajo, 25 alto y 5 transporte bajo. 25 pacientes con falla tipo I de ultrafiltración y 55 con UFR adecuada.La PET, es una prueba muy útil para clasificar el tipo de transporte peritoneal y conocer la tasa de UFR. Permite adecuar la DP y decidir en qué tipo de modalidad de DP puede estar el paciente.

Comparison of acquired cystic kidney disease between hemodialysis and continuous ambulatory peritoneal dialysis

OBJECTIVES: ACKD has been described mainly in patients treated with hemodialysis(HD), and there are only a few reports about the prevalence of ACKD in continuous ambulatory peritoneal dialysis (CAPD) patients. Therefore, we compared the prevalence of ACKD in patients receiving HD and CAPD, and evaluated the possible factors which may affect the development of ACKD. METHODS: Forty nine HD and 49 CAPD patients who had received dialysis therapy for at least 12 months were enrolled in this cross-sectional study. Patients who had a past history of polycystic kidney disease and had acquired cystic kidney disease on predialysis sonographic exam were excluded. Detection of ACKD was made by ultrasonography and ACKD was defined as 3 or more cysts in each kidney. RESULTS: The prevalence of ACKD was about 31+ACU- (30/98) and there was no significant difference between HD and CAPD patients(27+ACU- vs. 34+ACU-, p +AD4- 0.05). The prevalence of ACKD was not associated with age, sex, primary renal disease, the levels of hemoglobin, BUN, and serum creatinine. However, the duration of dialysis was significantly related to the development of ACKD (presence of ACKD, 74.4 42.4 months vs. absence of ACKD, 37.8 24.1 months, p +ADw- 0.05). CONCLUSION: The prevalence of ACKD is not different according to the mode of dialysis, and the major determinant of acquired cyst formation is duration of dialysis.

Adequação da diálise em pacientes sob diálise peritoneal ambulatorial contínua (DPAC) - (Nota Prévia)

A adequação da diálise objetiva minimizar as consequências negativas da subdiálise. Estudos analisando a cinética da uréia foram realizados em 20 pacientes em programas tandard de DPAC. Não houve relação entre KT/V (um índice de avaliação de diálise) e o ritmo de catabolismo protéico normalizado (PCRN). O principal determinante do KT/V da uréia foi o peso atual

Peritonite esclerosante e encapsulante secundária à diálise peritoneal ambulatorial contínua / sclerosing encapsulating peritonitis secundary by the continuous ambulatory peritoneal dialysis

A diálise peritoneal ambulatorial contínua (DPAC) é uma modalidade terapêutca eficiente para o tratamento da insuficiência renal crônica. A peritonite esclerosante e encapsulante (PEE) é uma conplicaçäo rara e grave da DPAC, associada com alta taxa de mortalidade e que ocorre, geralmente, após um tempo prolongado em tratamento complicado com episódios graves e recorrentes de peritonites. Relatamos três casos de PEE, entre 222 pacientes sob DPAC no Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, no período de 1984 e 1997, diagnosticados nos últimos 3 anos: dois casos do sexo feminino e um, do masculino, com tempo médio em DPAC de 55,3 meses e média de 4,3 episódios de peritonite. Os três pacientes apresentaram quadro clínico de obstruçäo intestinal e dois deles usavam B-bloqueador. Enfocamos a necessidade de prevençäo da PEE, o diagnóstico precoce e as recentes opçöes terapêuticas para reduçäo de sua morbidade e de sua mortalidade.(au)

Diálisis peritoneal ambulatoria: características epidemiológicas / Ambulatory peritoneal dialysis: epidemiologic characteristics

Objetivo: informar algunas características epidemiológicas de los pacientes integrados al programa de diálisis peritoneal ambulatoria. Diseño: cohorte descriptiva. Material y métodos: se evaluaron pacientes mayores de 15 años sometidos a diálisis peritoneal ambulatoria, atendidos en el Departamento de Medicina Interna del Hospital General, Centro Médico Nacional La Raza, dividiéndolos en dos grupos: diabéticos y no diabéticos. Se aplicaron varias pruebas estadísticas para calcular incidencia, prevalencia, sobrevida en el programa y casos de peritonitis. Resultados: Se incluyeron en forma consecutiva 215 pacientes: 121 diabéticos tipo 2 (56.2 por ciento) y 94 no diabéticos (43.7 por ciento), atendidos entre el 1 de agosto de 1995 al 30 de agosto de 1997. La edad promedio fue de 53.7 ñ 16.2 años. La incidencia fue de 5.3 ñ 2.8 casos al mes; el análisis de regresión lineal mostró un incremento no significativo. La prevalencia fue de 86.8 ñ 8.4 casos, con un incremento de 12.6 por ciento por año (p < 0.00001). La tasa de prevalencia estimada fue de 404 por cada millón de personas mayores de 15 años. La sobrevida en los pacientes diabéticos fue de 44 por ciento a los 12 meses, de 14.5 por ciento a los 24 y de 5.4 por ciento a los 36. La sobrevida de los pacientes no diabéticos fue de 77.5 por ciento a los 12 meses, de 62.1 por ciento a los 24 y de 35.5 por ciento a los 36 (p < 0.0000009). El seguimiento acumulado fue de 2179 meses-paciente, con un episodio de peritonitis cada 7.7 meses-paciente (1.5 por paciente al año). Conclusión: la diabetes mellitus tipo 2 es actualmente la causa más frecuente de insuficiencia renal crónica en fase terminal. La sobrevida de los pacientes diabéticos es mucho menor que la de los no diabéticos

Adecuación de la diálisis peritoneal continua ambulatoria en pediatría / Adecuacy of continuous ambulatory peritoneal dialysis in children

When the use of dialytical therapy is decided after a careful assessment of clinical and laboratory variables, the close supervision of the procedure, that allows a feedback between our indications and its clinical efficacy, is essential. The correct and routine use of validated adequacy tools such as Kt/V and the Peritoneal Equilibration Test (PET) is mandatory. We compare the adequacy figures for adult and pediatric populations, mentioning the Kt/V and PET values obtained in eight patients followed during 12 months in a Nephrology Unit. An initial Kt/V of 2.04 and of 2.14 after 12 months of procedure are values that adjust to the general recommendations discussed in this paper. According to PET results, this group of patients were classified as low average for ultrafiltration and high average for creatinine clearance. Based on the local experience and literature review, some recommendations are made for the management of peritoneal dialysis in children

Técnica quirúrgica para colocación del catéter de Tenckhoff / Surgical technique for Tenckhoff catheter placing

Esta técnica quirúrgica de colocación de catéter de Tenckhoff ha sido desarrollada a través de 14 años en el Hospital ®Dr. Darío Fernández¼ del ISSSTE en un total de 412 pacientes. Este procedimiento permite un largo funcionamiento del catéter evitando reoperaciones frecuentes e infecciones, además de proporcionar comodidad al paciente. Lo anterior se logra mediante la perfecta fijación del catéter tanto en la cavidad peritoneal, como en el espesor de la pared abdominal, la adecuada colocación de los cojinetes y la altura de la salida del tercer segmento. El primer segmento, que es el peritoneal, queda perfectamente fijo en el fondo de saco de Douglas, sitio más profundo de la cavidad pélvica, lo que garantiza la fácil entrada y drenaje completo de la solución. El primer cojinete colocado entre peritoneo y aponeurosis permanece fijo, lo que ayuda a la inmovilidad del segmento peritoneal y constituye el punto más importante de fijación del catéter. Lo anterior contribuye también a que el segundo segmento permanezca fijo en el espesor del tejido celular subcutáneo. El segundo cojinete también queda fijo gracias a la distancia entre éste y la emergencia del catéter y el punto de refuerzo en la piel. La salida del segmento libre debe ubicarse a nivel de la cicatriz umbilical y a la izquierda de ésta. Con este procedimiento hemos logrado un buen funcionamiento del catéter hasta por cinco años y con mínimas complicaciones e infecciones

Técnica quirúrgica antifuga en el implante de catéter de Tenckhoff para diálisis peritoneal / Antileaking surgical technique in implantation of Tenckhoff's catheter for peritonal dialisis

Se realizó un estudio experimental, prospectivo, comparativo, de selección aleatoria y ciego en los Hospitales Nuevo Civil y México Americano de Guadalajara, de enero a diciembre de 1994, en que se analizaron dos procedimientos utilizados para disminuir hiperazoemia en pacientes con insuficiencia renal crónica o aguda, con la finalidad de establecer eficiencia obtenida mediante la aplicación de catéteres de diálisis peritoneal rectos y curvos a la cavidad peritoneal. En ambas técnicas se fijo firmemente el catéter a la aponeurosis peritoneal o posterior del músculo recto anterior del abdomen. Distribuimos 90 pacientes en dos grupos de 45, para comparar la técnica quirúrgica original de colocación de catéter de diálisis frente a una técnica que denominamos "antifuga". El objetivo principal es demostrar que utilizando la técnica antifuga y clasificando la consistencia de la aponeurosis posterior del músculo recto anterior del abdomen (APRA) y utilizando el grosor de la sutura según su firmeza, pudiera existir un menor número de fugas, infecciones del túnel subcutáneo e infección en el sitio de salida de la pared abdominal, además de disminuir otras complicaciones secundarias, como son: dehiscencia, herniación e infección de la herida quirúrgica. Con base a los resultados de este estudio experimental concluimos que existe correlación entre la fuga temprana de soluciones con la técnica original y con la edad, grado de obesidad y APRA de los pacientes. Además, que el de catéteres en espiral fallan que menor frecuencia que los rectos, por lo que recomendamos la técnica antifuga y el empleo de catéteres en espiral en el manejo de diálisis peritoneal ambulatoria para pacientes con insuficiencia renal crónica

Diálisis peritoneal: una renaciente alternativa de tratamiento para la insuficiencia renal crónica en Chile / Peritoneal dialysis: a new alternative of treatment of chronic renal insuficiency in Chile

La diálisis peritoneal continua ambulatoria (DPCA) es un método de tratamiento para pacientes portadores de insuficiencia renal terminal. Este procedimiento puede ser realizado en forma autónoma por parte de los pacientes en su propia habitación o trabajo. La depuración de sustancias urémicas tiene lugar en forma continua durante las veinticuatro horas del día. Presenta especiales ventajas para pacientes que tengan necesidad de independencia, que deseen hacerse cargo de su propio tratamiento de diálisis, para pacientes con inestabilidad cardiovascular y/o anemia severa, pudiendo ser ventajosa también en otras indicaciones. La tecnología actual comprende un sistema de doble bolsa colapsable, y sistemas de conexión que han permitido reducir la incidencia de peritonitis a un episodio cada cuatro años por paciente. Sus resultados en mortalidad y morbilidad son similares a la hemodiálisis. La reciente introducción de esta técnica en nuestro país enriquece las posibilidades de tratamiento de los pacientes portadores de insuficiencia renal crónica