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2.
J. bras. nefrol ; 41(4): 550-559, Out.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1056604

ABSTRACT

Abstract Fluid volume and hemodynamic management in hemodialysis patients is an essential component of dialysis adequacy. Restoring salt and water homeostasis in hemodialysis patients has been a permanent quest by nephrologists summarized by the 'dry weight' probing approach. Although this clinical approach has been associated with benefits on cardiovascular outcome, it is now challenged by recent studies showing that intensity or aggressiveness to remove fluid during intermittent dialysis is associated with cardiovascular stress and potential organ damage. A more precise approach is required to improve cardiovascular outcome in this high-risk population. Fluid status assessment and monitoring rely on four components: clinical assessment, non-invasive instrumental tools (e.g., US, bioimpedance, blood volume monitoring), cardiac biomarkers (e.g. natriuretic peptides), and algorithm and sodium modeling to estimate mass transfer. Optimal management of fluid and sodium imbalance in dialysis patients consist in adjusting salt and fluid removal by dialysis (ultrafiltration, dialysate sodium) and by restricting salt intake and fluid gain between dialysis sessions. Modern technology using biosensors and feedback control tools embarked on dialysis machine, with sophisticated analytics will provide direct handling of sodium and water in a more precise and personalized way. It is envisaged in the near future that these tools will support physician decision making with high potential of improving cardiovascular outcome.


Resumo O volume de fluidos e o controle hemodinâmico em pacientes em hemodiálise é um componente essencial da adequação da diálise. A restauração da homeostase do sal e da água em pacientes em hemodiálise tem sido uma busca constante por parte dos nefrologistas, no que condiz à abordagem do "peso seco. Embora essa abordagem clínica tenha sido associada a benefícios no desfecho cardiovascular, recentemente tem sido questionada por estudos que mostram que a intensidade ou agressividade para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos.para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos. Uma abordagem mais precisa é necessária para melhorar o desfecho cardiovascular nessa população de alto risco. A avaliação e monitorização do estado hídrico baseiam-se em quatro componentes: avaliação clínica, ferramentas instrumentais não invasivas (por exemplo, US, bioimpedância, monitorização do volume sanguíneo), biomarcadores cardíacos (e.g. peptídeos natriuréticos), algoritmos e modelagem de sódio para estimar a transferência de massa. O manejo otimizado do desequilíbrio hídrico e de sódio em pacientes dialíticos consiste em ajustar a remoção de sal e líquido por diálise (ultrafiltração, dialisato de sódio), e restringir a ingestão de sal e o ganho de líquido entre as sessões de diálise. Tecnologia moderna que utiliza biosensores e ferramentas de controle de feedback, hoje parte da máquina de diálise, com análises sofisticadas, proporcionam o manejo direto sobre o sódio e a água de uma maneira mais precisa e personalizada. Prevê-se no futuro próximo que essas ferramentas poderão auxiliar na tomada de decisão do médico, com alto potencial para melhorar o resultado cardiovascular.


Subject(s)
Humans , Sodium/metabolism , Renal Dialysis/adverse effects , Hemodynamics/physiology , Homeostasis/physiology , Kidney Failure, Chronic/therapy , Water-Electrolyte Balance/physiology , Blood Pressure/physiology , Algorithms , Biomarkers/metabolism , Dialysis Solutions/chemistry , Cardiovascular System/physiopathology , Renal Dialysis/standards , Treatment Outcome , Cardiovascular Deconditioning , Nephrologists/statistics & numerical data , Kidney Failure, Chronic/physiopathology
3.
J. bras. nefrol ; 41(4): 570-574, Out.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1056613

ABSTRACT

Abstract The occurrence of ascites after Renal Transplant (RT) is infrequent, and may be a consequence of surgical or medical complications. Case report: 61 year-old, male, history of arterial hypertension, tongue carcinoma and alcoholic habits 12-20g/day. He had chronic kidney disease secondary to autosomal dominant polycystic kidney disease, without hepatic polycystic disease. He underwent cadaver donor RT in September 2017. He had delayed graft function by surgically corrected renal artery stenosis. He was admitted in January 2018 for ascites de novo, with no response to diuretics. HE had visible abdominal collateral circulation. Graft dysfunction, adequate tacrolinemia, Innocent urinary sediment, mild anemia, without thrombocytopenia. Serum albumin 4.0g / dL. Normal hepatic biochemistry. Peritoneal fluid with transudate characteristics and serum albumin gradient > 1.1. Ultrasound showed hepatomegaly, permeable vascular axes, without splenomegaly. Mycophenolate mofetil was suspended, with reduced remaining immunosuppression. He maintained refractory ascites: excluded infectious, metabolic, autoimmune and neoplastic etiologies. No nephrotic proteinuria and no heart failure. MRI: micronodules compatible with bile cysts. Upper Digestive Tract Endoscopy did not show gastroesophageal varicose veins. Normal abdominal lymphoscintigraphy. He underwent exploratory laparoscopy with liver biopsy: incomplete septal cirrhosis of probable vascular etiology some dilated bile ducts. He maintained progressive RT dysfunction and restarted hemodialysis. The proposed direct measurement of portal pressure was delayed by ascites resolution. There was further recovery of the graft function. Discussion: Incomplete septal cirrhosis is an uncommon cause of non-cirrhotic portal hypertension. Its definition is not well known, morphological and pathophysiological. We have not found published cases of post-RT ascites secondary to this pathology, described as possibly associated with drugs, immune alterations, infections, hypercoagulability and genetic predisposition.


Resumo A ocorrência de ascite no pós-Transplante Renal (TR) é infrequente, podendo ser consequência de complicações cirúrgicas ou médicas. Caso clínico: 61 anos, masculino, antecedentes de hipertensão arterial, carcinoma da língua e hábitos alcoólicos 12-20g/dia. Doença renal crônica secundária à doença renal poliquística autossômica dominante, sem poliquistose hepática. Submetido a TR de doador cadáver em setembro de 2017. Atraso na função de enxerto por estenose da artéria renal, corrigida cirurgicamente. Internado em janeiro de 2018 por ascite de novo, sem resposta a diuréticos. Circulação colateral abdominal visível. Disfunção do enxerto, tacrolinemia adequada. Sedimento urinário inocente. Anemia ligeira, sem trombocitopenia. Albumina sérica 4,0g/dL. Bioquímica hepática normal. Líquido peritoneal com características de transudado e gradiente sero-ascítico de albumina > 1,1. Ecografia com hepatomegalia, eixos vasculares permeáveis, sem esplenomegalia. Suspendeu micofenolato mofetil, reduziu restante imunossupressão. Manteve ascite refratária: excluídas etiologias infecciosas, metabólicas, autoimunes e neoplásicas. Sem proteinúria nefrótica e sem insuficiência cardíaca. RM: micronódulos compatíveis com quistos biliares. EDA sem varizes gastroesofágicas. Linfocintigrafia abdominal normal. Submetido a laparoscopia exploradora com biópsia hepática: cirrose septal incompleta de provável etiologia vascular, alguns ductos biliares dilatados. Manteve disfunção progressiva do TR, reiniciou hemodiálise. Proposta medição direta da pressão portal, protelada por resolução da ascite. Recuperação posterior da função de enxerto. Discussão: A cirrose septal incompleta é uma causa incomum de hipertensão portal não cirrótica. A sua definição é morfológica e a fisiopatologia, pouco conhecida. Não encontramos publicados casos de ascite pós-TR secundária a esta patologia, descrita como possivelmente associada a fármacos, alterações imunitárias, infecções, hipercoagulabilidade e predisposição genética.


Subject(s)
Humans , Male , Middle Aged , Ascites/etiology , Kidney Transplantation/adverse effects , Renal Insufficiency, Chronic/surgery , Liver Cirrhosis/pathology , Ascites/diagnosis , Renal Dialysis/standards , Polycystic Kidney, Autosomal Dominant/complications , Delayed Graft Function/complications , Hypertension, Portal/etiology , Liver Cirrhosis/complications
4.
Rev. bras. enferm ; 72(4): 896-902, Jul.-Aug. 2019. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1020514

ABSTRACT

ABSTRACT Objective: To design and validate the content and format of a guidebook for chronic renal failure patients about the care with venous access for hemodialysis at home. Method: Methodological study, in which the steps for the guidebook design were: project planning, literature search, material content, and qualification selection. Results: After analysis of the articles, the content to be included in the guidebook was selected. The first draft of the guidebook was submitted for content and format validation, with the participation of 12 specialists. The necessary adjustments for the design of the final version were made with the help of an illustrator. Conclusion: The designed guidebook, "Hemodialysis: Care of Venous Accesses and Intercurrences at Home," consists of educational material to help hemodialysis patients with daily care with central venous catheter and arteriovenous fistula practices in case of intercurrences.


RESUMEN Objetivo: Construir y validar en contenido y apariencia un cuadernillo para el paciente renal crónico, respecto del cuidado de los accesos venosos para hemodiálisis en el domicilio. Método: Estudio metodológico. Las etapas para construir el cuadernillo fueron: elaboración del proyecto; búsqueda en la literatura; elección del contenido; y calificación del material. Resultados: Luego de analizarse los artículos encontrados, se seleccionó el contenido que integraría el cuadernillo. La primera versión del cuadernillo fue remitida a proceso de validación de contenido y apariencia, del que participaron 12 especialistas. Fueron consideradas las alteraciones necesarias con ayuda del ilustrador para confeccionar la versión final. Conclusión: El cuadernillo construido, "Hemodiálisis - Cuidado de los accesos venosos y complicaciones domiciliarias" constituye un material educativo capaz de ayudar al paciente en hemodiálisis con los cuidados diarios del catéter venoso central o fístula arteriovenosa, y en las conductas en caso de producirse complicaciones.


RESUMO Objetivo: construir e validar o conteúdo e a aparência de uma cartilha para o paciente renal crônico acerca dos cuidados com os acessos venosos para hemodiálise no domicílio. Método: estudo metodológico cujas etapas para construção da cartilha foram: elaboração do projeto, busca na literatura, escolha do conteúdo e qualificação do material. Resultados: após análise dos artigos encontrados, selecionou-se o conteúdo para compor a cartilha. A primeira versão da cartilha foi encaminhada para o processo de validação de conteúdo e aparência, com a participação de 12 especialistas. Atendeu-se às alterações necessárias, com auxílio do ilustrador, para confecção da versão final. Conclusão: a cartilha construída, Hemodiálise - Cuidados com acessos venosos e suas intercorrências no domicílio, consiste em um material educativo capaz de auxiliar o paciente em hemodiálise nos cuidados diários com o cateter venoso central ou fístula arteriovenosa e nas condutas, em casos de intercorrências.


Subject(s)
Humans , Male , Female , Adult , Pamphlets , Renal Dialysis/instrumentation , Renal Dialysis/methods , Central Venous Catheters/standards , Time Factors , Patient Education as Topic/methods , Patient Education as Topic/standards , Renal Dialysis/standards , Central Venous Catheters/adverse effects , Middle Aged
5.
Rev. bras. enferm ; 72(2): 314-320, Mar.-Apr. 2019. tab
Article in English | LILACS, BDENF | ID: biblio-1003480

ABSTRACT

ABSTRACT Objective: To translate and adapt the Patient Perceptions of Hemodialysis Scale (PPHS) to the Brazilian context. Method: A methodological study, in which the stages of initial translation, synthesis of translations, back translation, evaluation by an expert committee and pre-test of the PPHS were performed. Results: Two initial translations by independent translators, experienced in the health area and fluent in English. Subsequently, the synthesis of the translations was carried out, and this synthesis was back translated to the original language (American English).The translated and back-translated versions were evaluated by an expert committee made up of six PhD experts from the health area. The judges' evaluations resulted in content validity indexes for each item of the scale, and 7 of the 36 items had to be revised. Subsequently, a pretest was carried out with 20 participants, who considered the instrument intelligible. Conclusion: The PPHS is adequately translated and adapted to Brazilian Portuguese.


RESUMEN Objetivo: Traducir y adaptar la Patient Perceptions of Hemodialysis Scale (PPHS) al contexto brasileño. Método: Estudio metodológico, en el que se llevaron a cabo las etapas de traducción inicial, síntesis de las traducciones, retraducción, evaluación de la comisión de expertos y preprueba de la PPHS. Resultados: Dos traducciones iniciales fueron hechas por traductores independientes, con experiencia en traducción de textos en el campo de la salud y con fluidez en inglés. Posteriormente se llevó a cabo la síntesis de las traducciones, siendo retraducida al idioma original (inglés americano). Las versiones traducidas y retraducidas fueron evaluadas por la Comisión de expertos, compuesta por seis especialistas con posgrado en el campo de la salud. Las evaluaciones de los expertos implicaron el índice de validez de contenido para cada ítem de la escala, en la cual debían revisarse 7 de los 36 ítems. Después se realizó la preprueba con 20 participantes, quienes consideraron comprensible el instrumento. Conclusión: La PPH está traducida y adaptada al portugués brasileño.


RESUMO Objetivo: Traduzir e adaptar a Patient Perceptions of Hemodialysis Scale (PPHS) para o contexto brasileiro. Método: Estudo metodológico, no qual foram realizadas as etapas de tradução inicial, síntese das traduções, retrotradução, avaliação do Comitê de Especialistas e pré-teste da PPHS. Resultados: Foram realizadas duas traduções iniciais por tradutores independentes, com experiência em tradução de textos na área da saúde e fluentes em inglês. Posteriormente realizou-se a síntese das traduções, sendo esta retrotraduzida para o idioma original (inglês americano).As versões traduzidas e a retrotraduzida foram avaliadas pelo Comitê de Especialistas, constituído por seis doutores da área da saúde. As avaliações dos juízes resultaram nos índices de validade de conteúdo para cada item da escala, sendo que 7 dos 36 itens precisaram ser revistos. Posteriormente foi realizado o pré-teste com 20 participantes, os quais consideraram o instrumento compreensível. Conclusão: A PPHS encontra-se traduzida e adaptada para o português brasileiro.


Subject(s)
Humans , Male , Female , Adult , Patients/psychology , Perception , Psychometrics/standards , Renal Dialysis/standards , Psychometrics/instrumentation , Psychometrics/methods , Translating , Brazil , Surveys and Questionnaires , Reproducibility of Results , Renal Dialysis/methods , Renal Dialysis/psychology , Culturally Competent Care/methods , Culturally Competent Care/standards , Middle Aged
6.
Rev. bras. enferm ; 71(3): 1115-1121, May-June 2018. tab, graf
Article in English | LILACS, BDENF | ID: biblio-958626

ABSTRACT

ABSTRACT Objective: To measure the incidence of infection in short-term central venous catheter for hemodialysis and to identify the associated risk factors. Method: Prospective cohort study conducted in a teaching hospital from September 2015 to April 2016. Patients requiring central venous catheter for hemodialysis were included and data was collected through direct and systematic observation of the catheter insertion procedure by the researchers. Results: The final sample consisted of 69 patients, who used 88 catheters. The incidence of infection was 9.1%, and the risk factors were length of hospital stay and insertion of the catheter in the left femoral vein. Conclusion: The observation of the actions performed during the insertion of the catheter made it possible to identify the risk factors associated with infection, and the research protocol may have contributed to the reduction of infection rates.


RESUMEN Objetivo: Medir la incidencia de infección en catéter venoso central de permanencia corta para hemodiálisis e identificar los factores de riesgo asociados. Método: Cohorte prospectivo, desarrollado en un hospital de enseñanza, durante el período comprendido entre septiembre de 2015 y abril de 2016. Se incluyeron pacientes con necesidad de catéter venoso central para hemodiálisis, mediante observación directa y sistemática del procedimiento de inserción del catéter por los investigadores. Resultados: La muestra final fue de 69 pacientes, que hicieron uso de 88 catéteres. La incidencia de infección fue del 9,1%, y los factores de riesgo fueron el tiempo de internación y la inserción del catéter en vena femoral izquierda. Conclusión: La observación de las acciones realizadas en la inserción del catéter posibilitó la identificación de los factores de riesgo asociados a infección y el protocolo de investigación utilizado puede haber contribuido con la reducción de los índices de infección.


RESUMO Objetivo: Mensurar a incidência de infecção em cateter venoso central de curta permanência para hemodiálise e identificar os fatores de risco associados. Método: Coorte prospectiva, desenvolvida em hospital de ensino no período de setembro de 2015 a abril de 2016. Foram incluídos pacientes com necessidade de cateter venoso central para hemodiálise, mediante observação direta e sistemática do procedimento de inserção do cateter pelos pesquisadores. Resultados: A amostra final foi de 69 pacientes, que fizeram uso de 88 cateteres. A incidência de infecção foi de 9,1%, e os fatores de risco foram o tempo de internamento e a inserção do cateter em veia femoral esquerda. Conclusão: A observação das ações realizadas na inserção do cateter possibilitou identificar os fatores de risco associados a infecção, e o protocolo de pesquisa utilizado pode ter contribuído com a redução nos índices de infecção.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Incidence , Renal Dialysis/standards , Catheter-Related Infections/prevention & control , Central Venous Catheters/standards , Prospective Studies , Risk Factors , Renal Dialysis/methods , Kaplan-Meier Estimate , Catheter-Related Infections/epidemiology , Central Venous Catheters/adverse effects , Intensive Care Units/standards , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Middle Aged
7.
Rev. bras. enferm ; 71(2): 379-390, Mar.-Apr. 2018. graf
Article in English | LILACS, BDENF | ID: biblio-898448

ABSTRACT

ABSTRACT Objective: create and validate forms to subsidize the systematization of nursing care with people on hemodialysis. Method: institutional case study to support the systematization of assistance from the construction of forms for data collection, diagnoses, interventions and nursing results, using cross-mapping, Risner's reasoning, Neuman's theory, taxonomies of diagnoses, interventions and nursing results with application in clinical practice and validation by focal group with specialist nurses. Results: 18 people on hemodialysis and 7 nurses participated. Consensus content of form matter with specialist nurses in the area (Crombach 0.86). The papers captured 43 diagnoses, 26 interventions and 78 nursing results depicting human responses in their singularities. Final considerations: the validated forms fill a gap by enabling the capture of human responses from people on hemodialysis and by subsidizing the planning of nursing care on a scientific basis.


RESUMEN Objetivo: crear y validar impresos para subsidiar la sistematización del cuidado de enfermería con personas en hemodiálisis. Método: estudio de caso institucional para subsidiar la sistematización de la asistencia a partir de la construcción de impresos para recolección de datos, diagnósticos, intervenciones y resultados de enfermería, utilizando el mapeo cruzado, el raciocinio de Risner, la teoría de Neuman, taxonomías de diagnósticos, intervenciones y resultados de enfermería con aplicación en la práctica clínica y validación por grupo focal con enfermeras especialistas. Resultados: participaron 18 personas en hemodiálisis y 7 enfermeros. Consensuados contenidos de los impresos con enfermeras especialistas del área (Crombach 0,86). Los impresos captaron 43 diagnósticos, 26 intervenciones y 78 resultados de enfermería retratando respuestas humanas en sus singularidades. Consideraciones finales: los impresos validados llenan una brecha al posibilitar la captación de respuestas humanas de personas en hemodiálisis y al subsidiar la planificación de los cuidados de enfermería en bases científicas.


RESUMO Objetivo: criar e validar impressos para subsidiar a sistematização do cuidado de enfermagem com pessoas em hemodiálise. Método: estudo de caso institucional para subsidiar sistematização da assistência a partir da construção de impressos para coleta de dados, diagnósticos, intervenções e resultados de enfermagem, usando mapeamento cruzado, raciocínio de Risner, teoria de Neuman, taxonomias de diagnósticos, intervenções e resultados de enfermagem com aplicação na prática clínica e validação por grupo focal com enfermeiras especialistas. Resultados: participaram 18 pessoas em hemodiálise e 7 enfermeiros. Consensualizados conteúdos dos impressos com enfermeiras especialistas da área (Crombach 0,86). Os impressos captaram 43 diagnósticos, 26 intervenções e 78 resultados de enfermagem retratando respostas humanas em suas singularidades. Considerações finais: os impressos validados preenchem uma lacuna ao possibilitar a captação de: respostas humanas de pessoas em hemodiálise e ao subsidiar o planejamento dos cuidados de enfermagem em bases científicas.


Subject(s)
Humans , Male , Female , Adult , Aged , Records/standards , Reproducibility of Results , Renal Dialysis/methods , Patients/psychology , Quality of Health Care/standards , Brazil , Renal Dialysis/standards , Focus Groups , Middle Aged , Nurses/psychology
8.
Rev. méd. Chile ; 145(7): 888-895, jul. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-902562

ABSTRACT

Background: Knowing nurses' workload in hemodialysis units allows a better organization of human resources. Aim: To determine nurses' workload according to dependence and risk profiles of patients undergoing chronic hemodialysis. Material and Methods: One hundred fifty one patients from five hemodialysis units were selected and categorized in terms of dependence and risk using the instrument "Care according to dependence and risk in hemodialysis (CUDYR-DIAL). Nurses' activities for direct and indirect care and the time taken to complete those activities were measured. Results: Per patient, nurses used 36.5 ±10.7 min for direct and 23.6 min for indirect care. The time required for direct care of patients at high risk with partial dependence and at high risk and partial self-sufficiency was 41.2 and 40.3 minutes respectively. Conclusions: During a dialysis session, nurses occupy 60% of their time providing direct care, mainly directed to patients categorized as being of high risk-partial dependence and high risk-partial self-sufficiency.


Subject(s)
Humans , Male , Female , Middle Aged , Renal Dialysis/statistics & numerical data , Workload/statistics & numerical data , Patient Safety/standards , Nurses/statistics & numerical data , Brazil , Cross-Sectional Studies , Renal Dialysis/standards , Workload/standards , Risk Assessment , Nurses/standards , Nursing Care/standards , Nursing Care/statistics & numerical data
9.
Medicina (B.Aires) ; 77(2): 111-116, Apr. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-894442

ABSTRACT

Los pacientes que reciben dosis sub-óptima de hemodiálisis tienen mayor morbimortalidad. El objetivo del trabajo fue identificar los factores predisponentes y las principales causas de diálisis inadecuada y diseñar un algoritmo para aplicar en estos casos. Se realizó un estudio de corte transversal. Se incluyeron 90 pacientes en hemodiálisis crónica, en el Hospital Privado Universitario de Córdoba, en septiembre 2015. Veintidós recibieron una dosis sub-óptima de hemodiálisis. Aquellos con un volumen de distribución de urea (V) mayor a 40 l (72 kg de peso corporal aproximadamente), tienen 11 veces mayores posibilidades (OR = 11.6; IC95% = 3.2-51.7, p < 0.0001) de recibir una dosis inadecuada de hemodiálisis que los que tienen un V menor a esa cifra; y los hombres 3 veces más probabilidad que las mujeres (OR = 3.5; IC95% 1.0-15.8; p = 0.0292). El V mayor a 40 l fue el único factor independiente predictor de sub-diálisis en el análisis multivariado (OR = 10.3; IC95% 2.8-37; p = 0.0004). La principal causa de diálisis sub-óptima fue recibir un flujo sanguíneo (Qb) menor al prescripto (336.4 ± 45.8 vs. 402.3 ± 28.8 ml/min, respectivamente, p < 0.0001) (n = 18). Otras causas fueron: menor duración de la sesión (n = 2), recirculación del acceso vascular (n = 1) y error en las muestras (n = 1). En conclusión, el único factor independiente predisponente de sub-diálisis fue el V mayor a 40 l. La principal causa de diálisis inadecuada fue recibir un Qb menor al prescripto. A partir de estos hallazgos, se desarrolla un algoritmo para aplicar en estos casos.


Patients receiving sub-optimal dose of hemodialysis have increased morbidity and mortality. The objectives of this study were to identify predisposing factors and causes of inadequate dialysis, and to design a practical algorithm for the management of these patients. A cross-sectional study was conducted. Ninety patients in chronic hemodialysis at Hospital Privado Universitario de Córdoba were included, during September 2015. Twenty two received sub-optimal dose of hemodialysis. Those with urea distribution volume (V) greater than 40 l (72 kg body weight approximately) are 11 times more likely (OR = 11.6; CI 95% = 3.2 to 51.7, p < 0.0001) to receive an inadequate dose of hemodialysis, than those with a smaller V. This situation is more frequent in men (OR = 3.5; 95% CI 1.01-15.8; p = 0.0292). V greater than 40 l was the only independent predictor of sub-dialysis in the multivariate analysis (OR = 10.3; 95% CI 2.8-37; p < 0.0004). The main cause of suboptimal dialysis was receiving a lower blood flow (Qb) than the prescribed (336.4 ± 45.8 ml/min vs. 402.3 ± 28.8 ml/min respectively, p < 0.0001) (n = 18). Other causes were identified: shorter duration of the session (n = 2), vascular access recirculation (n = 1), and error in the samples (n = 1). In conclusion, the only independent predisposing factor found in this study for sub-optimal dialysis is V greater than 40 l. The main cause was receiving a slower Qb than prescribed. From these findings, an algorithm for the management of these patients was developed.


Subject(s)
Humans , Male , Female , Middle Aged , Renal Dialysis/standards , Kidney Failure, Chronic/therapy , Algorithms , Cross-Sectional Studies , Risk Factors , Renal Dialysis/methods
10.
Rev. bras. enferm ; 70(1): 31-38, jan.-fev. 2017. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-843612

ABSTRACT

RESUMO Objetivo: avaliar a efetividade de uma intervenção educacional de enfermagem para redução da hiperfosfatemia em pacientes renais crônicos em hemodiálise. Método: estudo quase experimental realizado com 63 pacientes hiperfosfatêmicos em hemodiálise. A intervenção se constituiu em orientar e disponibilizar um manual impresso e ilustrado aos pacientes, contendo informações sobre o controle da doença. Foi solicitado o preenchimento de um checklist diário, com finalidade recordatória dos aspectos abordados no manual. Os exames laboratoriais e a intensidade do prurido foram analisados no início do estudo, aos 30 e 60 dias após a intervenção educacional. Resultados: a média de idade dos participantes foi 58±13,1 anos e tempo de tratamento de 51,1±44,7 meses. Houve redução dos valores séricos do fósforo de 7,06±1,43 para 5,80±1,53 (p<0,001) e da intensidade do prurido após a intervenção. Conclusão: a Intervenção Educacional de Enfermagem foi efetiva para redução do fosfato e diminuição do prurido nos pacientes hiperfosfatêmicos.


RESUMEN Objetivo: evaluar la eficacia de una intervención educativa de enfermería para reducir hiperfosfatemia en pacientes con insuficiencia renal crónica en hemodiálisis. Método: estudio cuasi-experimental con 63 pacientes en hemodiálisis con hiperfosfatemia. La intervención consistió en guiar los pacientes y proporcionar un manual impreso e ilustrado con informaciones sobre el control de la enfermedad. Se solicitó completar una lista de verificación todos los días con el propósito de recordar los aspectos tratados en el manual. Se analizaron las pruebas de laboratorio y la intensidad del picor al inicio del estudio, 30 y 60 días después de la intervención educativa. Resultados: la edad promedio de los participantes fue 58±13,1 años y el tiempo de tratamiento fue 51,1±44,7 meses. Hubo reducción de los valores séricos de fósforo de 7,06±1,43 para 5,80±1,53 (p<0,001) y de la intensidad del picor después de la intervención. Conclusión: la intervención educativa de enfermería fue eficaz en la reducción de fosfato y disminución del picor en pacientes con hiperfosfatemia.


ABSTRACT Objective: to evaluate the effectiveness of an educational nursing intervention to reduce hyperphosphataemia in chronic renal patients on hemodialysis. Method: quasi-experimental study with 63 hyperphosphatemic patients on hemodialysis. The intervention consisted of developing and providing a printed and illustrated manual to patients containing information on disease control. The participant was asked to complete a daily checklist with the aim to reinforce aspects provided in the manual. Laboratory tests and itching intensity were analyzed at the beginning of the study, and at 30 and 60 days after the educational intervention. Results: the mean age of participants was 58±13.1 years, with a treatment time of 51.1±44.7 months. A reduction in serum phosphorus values of 7.06 ± 1.43 to 5.80 ± 1.53 (p <0.001) and the intensity of itching after the intervention was observed. Conclusion: the educational nursing intervention was effective in reducing phosphate and decreasing itching in hyperphosphatemic patients.


Subject(s)
Humans , Male , Female , Adolescent , Teaching/standards , Renal Dialysis/adverse effects , Hyperphosphatemia/prevention & control , Renal Dialysis/standards , Education, Nursing, Continuing/methods , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Hyperphosphatemia/etiology , Middle Aged
11.
J. bras. nefrol ; 38(1): 62-69, jan.-mar. 2016. tab
Article in Portuguese | LILACS | ID: lil-777503

ABSTRACT

Resumo Introdução: Alguns índices são utilizados para avaliar a qualidade da terapia dialítica oferecida aos pacientes com doença renal crônica (DRC). Em 2014, o Ministério da Saúde do Brasil publicou a Portaria n° 389/2014, que estabelece metas no cuidado desses pacientes. Objetivo: Avaliar o desempenho de diferentes clínicas de hemodiálise (HD) em relação às metas estabelecidas nessa Portaria. Métodos: Estudo transversal, prospectivo, observacional, envolvendo 1.633 pacientes em HD em oito clínicas. As características demográficas, Kt/V, hemoglobina, fósforo, paratormônio (PTH) e a taxa de mortalidade foram registradas. Os resultados foram comparados com as metas estabelecidas na Portaria: Kt/V > 1,2 em mais de 70% dos pacientes, hemoglobina entre 10 e 12g/dl em mais de 80%, fósforo entre 3,5 e 5,5mg/dl em mais de 50% e o PTH < 600pg/ml em mais de 80% dos pacientes. Resultados: A idade foi de 56,4 ± 15,2 anos, a mediana do tempo em diálise foi de 28,4 meses. A duração da HD foi de 3,74 ± 0,31 horas. Para o Kt/V, seis clínicas atingiram a meta. Para a hemoglobina, nenhuma clínica atingiu a meta. Para o fósforo, duas clínicas atingiram a meta e para o PTH quatro clínicas. Seis clínicas atingiram duas metas e duas clínicas não atingiram nenhuma meta. A mortalidade foi menor nas clínicas que atingiram metas (10,2vs. 21,6% ao ano; p = 0,0546). Conclusão: Para o Kt/V a maioria das clínicas atingiu a meta estabelecida. Para a hemoglobina e fósforo, as metas não foram atingidas na maioria das clínicas. Para o PTH, a resposta foi variável e dependente de características da clínica.


Abstract Introduction: Medical organizations have proposed indices to assess the quality of dialytic therapy offered to patients with chronic kidney disease (CKD). Recently, the Ministry of Health of Brazil published the ordinance n° 389/2014, which establishes targets in the care of patients with CKD. Objective: We evaluate the performance of hemodialysis (HD) clinics in relation to the goals established in this ordinance. Methods: Cross-sectional study, prospective, observational, involving 1,633 patients with CKD on HD in eight clinics. Demographic characteristics, Kt/V, hemoglobin, phosphorus, parathormone (PTH) and the mortality rate were recorded. The results were compared to the goals established in the ordinance No. 389/2014: Kt/V > 1.2 in more than 70% of patients, hemoglobin between 10 and 12 g/dl in more than 80%, phosphorus between 3.5 and 5.5 mg/dl in more than 50%, and PTH < 600pg/ml in more than 80% of patients. Results: The age was 56.4 ± 15.2 years, the median time on dialysis was 28.4 months. The HD session time was 3.74 ± 0.31 hours. For Kt/V, six clinics reached the goal. For hemoglobin, none of the clinics reached the goal. For phosphorus, only two clinics meet the goal and for PTH four clinics. Six clinics hit two goals and two clinics did not achieve any goal. Mortality was lower in clinics that reached targets (10.2vs. 21.6% per year; p = 0.0546). Conclusion: For Kt/V most clinics reached the goal established by the ordinance. For hemoglobin and phosphorus, the objectives were not achieved in many clinics. For PTH, the response was variable and dependent on clinical features.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Quality of Health Care , Renal Dialysis/standards , Kidney Failure, Chronic/therapy , Brazil , Cross-Sectional Studies , Prospective Studies
12.
Article in English | WPRIM | ID: wpr-35112

ABSTRACT

The number of hemodialysis patients and dialysis facilities is increasing each year, but there are no surveillance programs validating that the services and equipment of each hemodialysis unit meet specified safety and quality standards. There is a concern that excessive competition and illegal activities committed by some dialysis facilities may violate patients' right to health. Contrastingly, developed countries often have their own survey program to provide initial certification and monitoring to ensure that these clinics continue to meet basic requirements. Because hemodialysis units provide renal replacement therapy to critical patients suffering from severe chronic renal failure, appropriate legal regulation is important for the provision of initial certification and maintenance of facility, equipment, and human resource quality. Therefore, several standards providing minimum requirements for the area of hemodialysis unit, equipment for emergency care, physician and nurse staffs, water purification and quality management are urgently needed.


Subject(s)
Ambulatory Care Facilities/standards , Health Workforce , Humans , Renal Dialysis/standards , Republic of Korea
13.
Rev. cuba. salud pública ; 38(3): 451-462, jul.-sept. 2012.
Article in Spanish | LILACS | ID: lil-659863

ABSTRACT

La calidad microbiológica del agua para los tratamientos de hemodiálisis en los pacientes con enfermedad renal crónica es de vital importancia, con el fin de evitar o reducir el riesgo por infección al paciente, ya que la sangre de un paciente se pone en contacto con 20 000 a 25 000 litros de agua por año a través de una membrana. Hoy en día existen muchas discrepancias en las normativas y guías para la evaluación del agua de hemodiálisis, especialmente con respecto a los parámetros microbiológicos los que se encuentran en fase de armonización y son de crucial significado actual. El objetivo de este trabajo es aportar el enfoque actual existente para la evaluación de la calidad microbiológica del agua de hemodiálisis a nivel internacional y nacional y su incorporación en la vigilancia sanitaria nacional


The microbiological quality of haemodialysis water is vital for the treatment of patients suffering renal chronic disease, in order to avoid or reduce the risk of infection, since a patient's blood gets in contact with 20 000 to 25 000 litres of water per year through a membrane. There are many controversies at present regarding the regulations and guidelines for the evaluation of haemodialysis water, particularly the microbiological parameters which are undergoing a harmonization process and are highly significant. The paper was aimed at providing the current approach for the evaluation of the microbiological quality of haemodialysis water at domestic and international levels and the incorporation of such approach into the national health surveillance


Subject(s)
Water Microbiological Characteristics/methods , Renal Dialysis/standards
14.
Cochabamba; s.n; dic. 2011. 173 p. tab, graf.
Thesis in Spanish | LILACS, LIBOCS, LIBOE | ID: biblio-1296154

ABSTRACT

La insuficiencia renal crónica es la disminución progresiva de la tasa de filtrado glomerular secundario a pérdida irreversible de nefronas funcionantes, y como alternativa de tratamiento se tiene la hemodiálisis.La presente investigación es cuantitativa y cualitativa, de tipo descriptivo, transversal y retroprospectivo; demuestra el manejo de los accesos vasculares en hemodiálisis por parte del personal de salud en enfermería y pacientes. Se trabajo con una muestra de 176 pacientes y 17 Licenciadas de enfermería de dos instituciones de salud; Caja Nacional de salud y el Hospital Clínico Viedma en el año 2011.Se utilizó un cuestionario para los pacientes y el personal de salud, donde los resultados reflejaron que existe un déficit de conocimientos en cuanto al manejo de los accesos vasculares por parte del paciente y el personal de enfermería; lo cual se asocia con las complicaciones observadas. Se observó una mayor incidencia de infección causada por el mal uso por parte de los pacientes. Se constató los procedimientos mal realizados en accesos vasculares por el personal de salud en enfermería, con mayor incidencia en la institución de la Caja Nacional de Salud


Subject(s)
Patient Care/nursing , Renal Dialysis/nursing , Renal Dialysis/standards , Hemostatic Disorders/complications , Hemostatic Disorders/prevention & control , Hemodialysis Units, Hospital , Hemodialysis Units, Hospital/organization & administration , Bolivia
15.
Rev. latinoam. enferm ; 19(4): 953-959, July-Aug. 2011.
Article in English | LILACS, BDENF | ID: lil-597091

ABSTRACT

This study analyzes the factors, which from the perspective of the health team and users, hinder the implementation of integrality in care provided by a dialysis facility. This qualitative study collected data through semi-structured interviews held with 16 health professionals and eight users from a university hospital in Rio Grande do Sul, Brazil. Data were analyzed through thematic content analysis. Among the factors that hinder the implementation of integrality in hemodialysis care, the following were highlighted: a deficient service network, delay in accessing diagnostic exams and consultations with specialists, and a reduced number of professionals in the support team. The conclusion is that the health services network needs to be expanded and an effective interface between such networks and dialysis services needs to be established in order to overcome the reported difficulties and contribute to the implementation of integrality in dialysis care.


Este artigo teve como objetivo analisar, sob a ótica da equipe de saúde e dos usuários, os fatores que podem dificultar a prática da integralidade do cuidado em uma unidade de hemodiálise. Trata-se de pesquisa qualitativa, cujos dados foram coletados por meio de entrevista semiestruturada, com dezesseis profissionais de saúde e oito usuários de um hospital de ensino do Rio Grande do Sul, tendo sido, posteriormente, feita a análise de conteúdo temática. Essa análise sugeriu que, dentre os fatores que dificultam a prática da integralidade no cuidado em hemodiálise, se destacaram deficiências na rede de serviços, demora no acesso a exames diagnósticos e a consultas com médicos especialistas e reduzido número de profissionais nas equipes de apoio. Concluiu-se, então, que a ampliação na rede de serviços de saúde e o estabelecimento de interface efetiva entre os serviços de hemodiálise e essa rede poderão representar a superação das dificuldades apontadas, e, assim, contribuir para a integralidade no cuidado em hemodiálise.


Este artículo tuvo como objetivo analizar, bajo la óptica del equipo de salud y de los usuarios, los factores que pueden dificultar la práctica de la integralidad del cuidado en una unidad de hemodiálisis. Se trata de investigación cualitativa, cuyos datos fueron recolectados, por medio de entrevista semiestructurada, con dieciséis profesionales de salud y ocho usuarios de un hospital de enseñanza de Rio Grande del Sur, habiendo sido, posteriormente, hecho el análisis de contenido temático. Ese análisis sugiere que, entre los factores que dificultan la práctica de la integralidad en el cuidado en hemodiálisis, se destacaron deficiencias en la red de servicios, demora en el acceso a exámenes de diagnóstico y a consultas con médicos especialistas, y reducido número de profesionales en los equipos de apoyo. Se concluye, entonces, que la ampliación en la red de servicios de salud y el establecimiento de una conexión efectiva entre los servicios de hemodiálisis y esa red podrán representar la superación de las dificultades apuntadas, y, así, contribuir para la integralidad del cuidado en hemodiálisis.


Subject(s)
Humans , Renal Dialysis/standards , Integrative Medicine
16.
Rev. nefrol. diál. traspl ; 30(2): 97-99, mar. 2010. ilus
Article in Spanish | LILACS | ID: lil-576006

ABSTRACT

La hemodiálisis es un procedimiento terapéutico suficientemente seguro del que dependen alrededor de un millón de personas en todo el mundo. No obstante, la realización de HD supone someter al paciente a una circulación extra corpórea durante el cual la sangre se pone en contacto con materiales sintéticos y soluciones de diversa composición que pueden afectar el equilibrio del paciente. Esto hace que la misma se acompañe, a veces, de complicaciones importantes y potencialmente graves que pueden incluso originar la muerte.


Subject(s)
Renal Dialysis/nursing , Renal Dialysis/standards
17.
Article in Korean | WPRIM | ID: wpr-35380

ABSTRACT

OBJECTIVES: This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid. METHODS: This study used data from sampled hospitals that provided a hemodialysis service. A total of 2287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time, erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as: hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best). RESULTS: There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI=0.43-0.99). However, frequency of hemodialysis, hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb> or =11 g/dL, blood pressure within the range of 100-140/60-90 mmHg, calcium x phosphate or =4 g/dL were not significantly different between the groups. CONCLUSIONS: There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis.


Subject(s)
Aged , Female , Humans , Insurance, Health/classification , Male , Medical Audit , Middle Aged , Quality Indicators, Health Care , Quality of Health Care , Renal Dialysis/standards , Republic of Korea
18.
Cir. & cir ; 77(5): 411-415, sept.-oct. 2009. tab
Article in Spanish | LILACS | ID: lil-566464

ABSTRACT

Los tratamientos sustitutivos de diálisis crónica o trasplante renal se inician cuando la filtración glomerular del paciente medida por la depuración de creatinina endógena en la orina de 24 horas es inferior a 15 o 10 ml/mm y cuando se presentan complicaciones. A los enfermos con indicaciones de trasplante se les debe buscar un donador vivo seleccionado o inscribirlos en la lista de espera nacional de donación cadavérica si no existen contraindicaciones. Aun cuando no hay un registro nacional mexicano de pacientes en diálisis crónica, solo datos indirectos de la Fundación Mexicana del Riñón y de la industria de diálisis, se estima que de 40 mil a 50 mil son sujetos a este tratamiento y que anualmente la cifra se incrementa 11 %. En términos generales se considera que por cada enfermo en diálisis crónica hay otro que fallece sin acceso al tratamiento. Las unidades de hemodiálisis deben cumplir con la norma oficialmexicana de hemodiálisis y la cédula de evaluación de la calidad de las unidades de hemodiálisis del Consejo de Salubridad General. Es aconsejable que los pacientes sean incorporados a diálisis crónica después de ser presentados al comité de diálisis, y que el tratamiento se aplique con la aceptación del enfermo o sus familiares y se registre en el censo nominal.


Chronic dialysis replacement treatments or renal transplants are instituted when the patient's glomerular filtration rate, measured by 24-h urine endogenous creatinine clearance, is <10-15 ml/mm and, as the The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI), European and Canadian guidelines point out, when one or two of the following complications occur: "uremic toxicity" symptoms, significant fluid retention that does not respond to loop diuretics, hyperkalemia, chronic anemia (hemoglobin <8 g), metabolic acidosis or acute pulmonary edema. In all patients for whom transplant is indicated, a selected live donor must be sought or, in the absence of contraindications, the patient should be registered with the national cadaver donation waiting list. While waiting for the transplant, patients will be on a chronic dialysis program. There is no national registry of patients undergoing chronic dialysis; only indirect data from the Mexican Kidney Foundation and the dialysis industry are available. However, it is estimated that 40,000-50,000 people are under this treatment and the numbers grow by 11% every year. Overall, it is thought that for every patient receiving chronic dialysis, there is one more patient who dies without access to therapy. Hemodialysis units must comply with the Official Hemodialysis Standard and the General Health Council Hemodialysis Unit Quality Assessment Form.


Subject(s)
Humans , Kidney Failure, Chronic/therapy , Renal Replacement Therapy/statistics & numerical data , Outpatient Clinics, Hospital/statistics & numerical data , Cause of Death , Diagnosis-Related Groups , Peritoneal Dialysis/standards , Peritoneal Dialysis/statistics & numerical data , Renal Dialysis/standards , Renal Dialysis/statistics & numerical data , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/surgery , Health Services Needs and Demand , Hospital Mortality , Hospitals, Urban/statistics & numerical data , Mexico , Diabetic Nephropathies/complications , Records , Registries/statistics & numerical data , Kidney Transplantation/statistics & numerical data , Uremia/etiology , Uremia/therapy , Waiting Lists
19.
West Indian med. j ; 58(3): 235-242, June 2009. graf, tab
Article in English | LILACS | ID: lil-672478

ABSTRACT

BACKGROUND: Quality of Life (QOL) in patients with End Stage Renal Disease (ESRD) is an important measure of dialysis adequacy. Health related QOL is an independent risk factor for mortality in ESRD. The Kidney Disease QOL questionnaire is a highly validated disease targeted instrument with global application. We sought to document QOL and the predictive factors in a cohort of patients with ESRD in Jamaica and Panama. METHODS: Two hundred patients were recruited consecutively from November 2006 - November 2007. Seventy patients were from a tertiary hospital based outpatient dialysis centre, the University Hospital of the West Indies (UHWI), and 40 patients from a private centre, Diabetes Association Renal Unit (DARU) both in Kingston, Jamaica. Ninety patients were consecutively recruited from a tertiary hospital based outpatient dialysis centre in Panama City, Panama. The Kidney Disease Quality of Life - Short Form Questionnaire was administered. Each QOL domain was scored from 0 - 100 with higher scores representing better rating. RESULTS: Mean age was 50 ± 4 years, with no difference between the cohorts. Panama, however, had significantly higher parameters than the Jamaican cohorts: mean haemoglobin (Hb) 12.4g/dL (p = 0.004), mean serum albumin 45g/dL (p = 0.03) and Urea Reduction Ratio (URR) 78% (p = 0.004). Diabetes Association Renal Unit recorded mean Hb 11.4 ± 1.3g/dL, mean serum albumin 42.1 ± 2.3g/dL and URR 72%. The University Hospital of the West Indies documented mean Hb 11.2 ± 2.4g/dL, mean serum albumin 41 ± 4.5g/dL and URR 68%. All three cohorts had good overall QOL scores when compared with the reference population. Patients from Panama had higher overall QOL scores than Jamaican patients (p = 0.02). By centre, UHWI had higher overall QOL scores than DARU (p = 0.04). Burden of Kidney Disease domain recorded the lowest overall scores (Reference Population 49, DARU 19.0 (p = 0.001), UHWI 24.0 (p = 0.002), Panama 32.9 (p = 0.03). Patient Satisfaction scores were also significantly reduced across all cohorts (Reference population 72, DARU 52, UHWI 54, Panama 58). The University Hospital of the West Indies had significantly decreased dialysis staff encouragement (p = 0.003). The Diabetes Association Renal Unit noted significant reductions in general health (p = 0.04), physical functioning (p = 0.001), physical role (p = 0.001) and emotional role (p = 0.005) domains. Panama had the lowest overall physical functioning (p = 0.01), pain (p = 0.01) and social support (p = 0.04) scores. In the Panamanian cohort, age < 65 years (p = 0.0004). Hb > 11.1 g/dL (p = 0.01), albumin > 40 g/dL (p = 0.01), URR > 65% (p = 0.03), race (p = 0.04), at least high school educational attainment (p = 0.01) and household yearly salaries > US$5000 (p = 0.002) predicted good QOL scores. These accounted for 55% of the variance. In the Jamaican cohort, however, younger age (p = 0.02), race (p = 0.001), higher URR (p = 0.01) and higher serum haemoglobin (p = 0.001) predicted higher QOL scores, accounting for only 40% of the variance. By modality, haemodialysis patients had significantly higher haemoglobin (p = 0.003) and albumin (p = 0.002) levels and ultimately higher overall QOL scores (p = 0.01). CONCLUSION: Overall, QOL is good in patients with ESRD. Domains of highest concern include Burden of Kidney Disease and Patient Satisfaction. The role of spirituality, depression and nutritional markers (eg prealbumin) needs to be assessed. Quality of Life must therefore be routinely documented in ESRD patients and targeted interventions implemented.


ANTECEDENTES: La calidad de vida (CDV) en los pacientes con enfermedad renal en etapa terminal (ERET) es un importante indicador de la medida en que la diálisis es adecuada. La CDV relacionada con la salud es un factor de riesgo independiente con respecto a la mortalidad en la ERET. El Cuestionario de Calidad de Vida en la Enfermedad Renal (KDQOL-SF) es un instrumento dirigido a la enfermedad, altamente validado y con aplicación global. Buscamos documentar la CDV y los factores predictivos en una cohorte de pacientes con ERET en Jamaica y Panamá. MÉTODOS: Se reclutaron doscientos pacientes consecutivamente de noviembre 2006 a noviembre 2007. Setenta pacientes provenían de un centro de diálisis para pacientes externos con base en un hospital terciario (HUWI) y 40 pacientes provenían de una Unidad Renal de la Asociación de Diabetes (DARU), ambas en Kingston, Jamaica. Otros noventa pacientes fueron reclutados consecutivamente de un centro de diálisis con base en un hospital de Ciudad Panamá. Se administró el Cuestionario de Calidad de Vida en la Enfermedad Renal (KDQOL-SF). Cada dominio de la CDV fue evaluado con una puntuación de 0 - 100, representando las puntuaciones más altas los mejores índices. RESULTADOS: La edad promedio fue de 50 ± 4 años, sin diferencias entre las cohortes. Sin embargo, Panamá tuvo parámetros significativamente más altos que las cohortes jamaicanas. El promedio de hemoglobina (Hb) fue 12.4g/dL (p = 0.004), el promedio de albúmina sérica 45g/dL (p = 0.03) y hubo una relación de reducción de la urea (URR) del 78% (p = 0.004). La Unidad Renal de Asociación de Diabetes registró un promedio de Hb de 11.4 ± 1.3 g/dL, y un promedio de albúmina sérica de 42.1 ± 2.3 g/dL en tanto que la URR fue 72%. El Hospital Universitario de West Indies documentó un promedio de Hb igual a 11.2 ± 2.4g/dL, una albúmina sérica promedio de 41 ± 4.5g/dL, y una URR de 68%. Las tres cohortes tuvieron buenas puntuaciones generales de CDV cuando se les comparó con la población de referencia. Los pacientes de Panamá tuvieron puntuaciones de CDV más altas que los pacientes jamaicanos (p = 0.02). En cuanto a centros, HUWI tuvo puntuaciones generales de CDV más altas que DARU (p = 0.04). El dominio de la sobrecarga de la enfermedad renal registró las puntuaciones generales más bajas (población de referencia 49, DARU 19.0 (p = 0.001), UHWI 24.0 (p = 0.002), Panamá 32.9 (p = 0.03). Las puntuaciones con respecto a la satisfacción del paciente estuvieron también significativamente reducidas en todas las cohortes (población de referencia 72, DARU 52, HUWI 54, Panamá 58). El Hospital Universitario de West Indies tuvo una disminución significativa del estímulo del personal de diálisis (p = 0.003). La Unidad Renal de la Asociación de Diabetes registró reducciones significativas en los dominios de la salud general (p = 0.04), el funcionamiento físico (p = 0.001), el rol físico (p = 0.001) y el rol emocional (p = 0.005). Panamá tuvo las puntuaciones más bajas en relación con el funcionamiento físico general (p = 0.01), el dolor (p = 0.01) y el apoyo social (p = 0.04). En la cohorte panameña, la edad < 65 años (p = 0.0004), la Hb > 11.1 g/dL (p = 0.01), la albúmina > 40g/dL (p = 0.01), la URR > 65% (p = 0.03), la raza (p = 0.04), el grado de escolaridad de nivel secundario al menos (p = 0.01) y los ingresos salariales domésticos por año > US$5000 (p = 0.002) arrojaron una buena predicción de la CDV. Estos representaban el 55% de la varianza. Sin embargo, en la cohorte jamaicana, una menor edad (p = 0.02), la raza (p = 0.001), una más alta URR (p = 0.01) y mayor hemoglobina sérica (p = 0.001) predijeron puntuaciones más altas de CDV, representando solamente 40% de la varianza. En cuanto a la modalidad, los pacientes de hemodiálisis tuvieron niveles de hemoglobina (p = 0.003) y albúmina (p = 0.002) significativamente más altos, y finalmente puntuaciones generales más alta de CDV (p = 0.01). CONCLUSIÓN: La CDV general es buena en los pacientes con ERET. Los dominios de mayor preocupación comprenden la recarga de la enfermedad renal y la satisfacción del paciente. El papel de la espiritualidad, la depresión y los marcadores nutricionales como la prealbúmina, necesitan ser evaluados. Por tanto, la calidad de vida tiene que ser documentada a modo de rutina entre los pacientes con ERET, y es necesario implementar intervenciones dirigidas.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Kidney Failure, Chronic/psychology , Quality of Life , Renal Dialysis/standards , Cohort Studies , Confidence Intervals , Cross-Sectional Studies , Health Status Indicators , Hemoglobins/analysis , Jamaica , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Linear Models , Nutritional Status , Panama , Patient Satisfaction/statistics & numerical data , Renal Dialysis/economics , Renal Dialysis/psychology , Socioeconomic Factors , Surveys and Questionnaires , Serum Albumin/analysis , Stress, Psychological/complications , Urea/blood
20.
Clinics ; 62(2): 145-150, Apr. 2007. graf
Article in English | LILACS | ID: lil-449654

ABSTRACT

OBJECTIVE: To study the effect of hemodialysis on intra-abdominal pressure. METHODS: Five patients admitted between July and November of 2003 were evaluated in the intensive care unit. Intra-abdominal pressure was measured before and after hemodialysis, maintaining the ventilatory parameters except for PEEP (positive-end expiratory pressure). RESULTS: Intra-abdominal pressure was significantly reduced by hemodialysis in all the 5 patients. CONCLUSION: Hemodialysis significantly reduced intra-abdominal pressure in the 5 patients, an effect which could have influence over other organic systems. This reduction is related to the weight variation before and after hemodialysis, as well as to the loss of volume caused by this procedure.


OBJETIVO: Pesquisar o efeito da hemodiálise sobre a pressão intra-abdominal. MÉTODOS: Foram avaliados cinco pacientes internados entre julho e novembro de 2003, na Unidade de Terapia Intensiva do Serviço de Nefrologia do Hospital das Clínicas de São Paulo. Mensurou-se a pressão intra-abdominal antes e após a hemodiálise, mantendo os parâmetros ventilatórios exceto a PEEP (positive end expiratory pressure). RESULTADOS: Constatou-se que a hemodiálise foi capaz de reduzir significativamente a PIA em cinco pacientes na Unidade de Terapia Intensiva CONCLUSÃO: A hemodiálise reduziu a pressão intra-abdominal numa amostra de cinco pacientes, de maneira significativa, o que poderia influenciar os demais sistemas orgânicos. Essa redução está relacionada com a variação de peso pré e pós-hemodiálise, e com a perda de volume promovida pelo procedimento.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Abdominal Cavity/physiopathology , Monitoring, Physiologic/methods , Renal Dialysis , Respiration, Artificial , Compartment Syndromes/diagnosis , Positive-Pressure Respiration , Renal Dialysis/adverse effects , Renal Dialysis/standards
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