Requerimiento de unidad de hemodiálisis en el eje este territorial del estado aragua, venezuela, 2014 / Requirement of hemodialysis unit in shaft this territorial aragua state, venezuela. 2014

Hemodialysis treatment defines a condition of life of chronicity and dependency in their patients, for its critical renal function, which must imperatively be supplemented. The objective of this research was to determine the population of this axis of Aragua State, in need of assistance in a hemodialysis unit. The Aragua State haemodialysis centres, recorded a population of 583 patients care, they were selected 83 chronic renal patients who applied a questionnaire to collect socio-demographic information, the characteristics of the treatment of hemodialysis and about their quality of life. The results demonstrate predominance of aged 55-64 years in 36%, 64% and residents male territorially this shaft 57%. Patients are 6 care centres, with waiting time for entry of 2 months and dialysis of the municipality Marine Unit attends to 34%. Patients at 89.2%, feel undermined their quality of life because of the travel time in the range of 1-2 hours, 41% are transferred by taxi. In its entirety, they claimed a local care center to improve their quality of life. These patients demonstrated involvement and impairment of physical, emotional and economic partner status by remoteness and transfer the service providing institutions.

El tratamiento de hemodiálisis define una condición de vida de cronicidad y dependencia en sus pacientes, por su función renal crítica, que imperativamente debe ser suplida. El objetivo de esta investigación, fue determinar la población del eje este del Estado Aragua, con necesidad de asistencia en una unidad de hemodiálisis. Los centros de atención de hemodiálisis del Estado Aragua, registran la atención de una población de 583 pacientes, de ellos fueron seleccionados 83 pacientes renales crónicos a quienes se les aplico un cuestionario para recabar información socio demográfica, las características del tratamiento de hemodiálisis y sobre su calidad de vida. Los resultados demuestran predominio de edades entre 55-64 años en 36%, sexo masculino en 64% y residentes territorialmente del eje este en 57%. Los pacientes corresponden a 6 centros de atención, con tiempo de espera para ingreso de 2 meses y la unidad de diálisis del Municipio Mariño atiende a 34%. Los pacientes en 89.2%, siente menoscabada su calidad de vida debido al tiempo de traslado en rango de 1-2 horas, 41% se trasladan en taxi. En su totalidad, demandaron un centro de atención más cercano para mejorar su calidad de vida. Estos pacientes manifestaron afectación y deterioro físico, emocional y en su condición socio económica por la lejanía y traslado a las instituciones prestadoras del servicio.

Nasal Colonization and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus among Hemodialysis Patients in 7 Korean Hospitals / 병원감염관리

BACKGROUND: Staphylococcus aureus is a major bacteremia-causing pathogen in hemodialysis patients, frequently colonizing patient skin and mucosa. Active infection control is necessary to prevent methicillin-resistant S. aureus (MRSA) infection in hospitals; however, the spread of community-associated MRSA has recently become a concern for MRSA infection control. We evaluated the nasal colonization of MRSA among hemodialysis patients and the molecular characterization of the MRSA isolates. METHODS: Nasal swabs were obtained from 482 hemodialysis patients in 7 nationwide hospitals in November 2009, and cultured for MRSA colonization. Swabs were inoculated and cultured in 6.5% NaCl tryptic soy broth, then subcultured on MRSASelect medium (Bio-Rad, Hercules, CA) for 20-24 h. Multiplex PCR was performed to analyze staphylococcal cassette chromosome mec (SCCmec) types of MRSA isolates. RESULTS: Of 482 hemodialysis patients, 57 (11.8%) carried MRSA, ranging from 6.7% to 19.0%. Among the 57 MRSA isolates, we identified 3 (5.3%) SCCmec II, 1 (1.8%) SCCmec IIA, 30 (52.6%) SCCmec IIB, 1 (1.8%) SCCmec III, 6 (10.5%) SCCmec IV, and 16 (28.1%) SCCmec IVA subtypes. CONCLUSION: The MRSA carriage rate (11.8%) of hemodialysis patients in this study was high. The SCCmec IIB subtype, a healthcare-associated strain, was the predominant strain, although SCCmec IV isolates, typically found in community-associated MRSA infections, were also frequently observed. To prevent healthcare-associated MRSA infections in hemodialysis patients, standardized infection control measures should be performed, and efforts to reduce MRSA carriage rates should be considered.

Efeitos do treinamento muscular inspiratório nos pacientes em hemodiálise / Effects of inspiratory muscle training in hemodialysis patients

INTRODUÇÃO: A doença renal crônica associada ao tratamento hemodialítico pode apresentar uma diversidade de complicações músculo-esqueléticas, além de trazer repercussões à função pulmonar. OBJETIVO: Avaliar os efeitos do treinamento muscular inspiratório na força muscular inspiratória, função pulmonar e capacidade funcional em pacientes com insuficiência renal crônica submetidos à hemodiálise. MÉTODO: Ensaio clínico não controlado, composto por 15 indivíduos com diagnóstico médico de insuficiência renal crônica, submetidos à hemodiálise. Foram avaliados pressões inspiratória máxima (PImáx) e expiratória máxima (PEmáx) através da manovacuometria; função pulmonar pela espirometria e a capacidade funcional através da distância percorrida e consumo de oxigênio obtido no teste da caminhada dos seis minutos (TC6M). No período de oito semanas, foi aplicado o protocolo de treinamento muscular respiratório (TMI) durante a sessão de hemodiálise, com carga estabelecida de 40 por cento da PImáx e uma frequência semanal de três dias alternados. RESULTADOS: Houve um aumento significativo na variável distância percorrida após o treinamento (455 ± 98 versus 558 ± 121; p = 0,003). Não foram encontradas diferenças estatísticas na comparação antes e após treinamento nas demais variáveis do estudo. CONCLUSÃO: O estudo não apresentou diferença estatística na força muscular respiratória, na função pulmonar e no consumo de oxigênio. Observou-se apenas um aumento na distância do TC6M.

INTRODUCTION: Chronic kidney disease associated with hemodialysis can have a variety of musculoskeletal complications, in addition to repercussions in pulmonary function. OBJECTIVE: To evaluate the effects of inspiratory muscle training on inspiratory muscle strength, pulmonary function, and functional capacity in patients with chronic kidney failure undergoing hemodialysis. METHOD: Non-controlled clinical trial, comprising 15 individuals diagnosed with chronic kidney failure and undergoing hemodialysis. Maximum inspiratory (PImax) and expiratory (PEmax) pressures were assessed by use of pressure vacuum meter reading. Pulmonary function was assessed by use of spirometry. Functional capacity was assessed by use of walked distance and oxygen consumption obtained in the six-minute walk test (6MWT). For eight weeks, the inspiratory muscle training (IMT) protocol was applied during hemodialysis sessions, with load set to 40 percent of PImax and weekly frequency of three alternate days. RESULTS: A significant increase in the walked distance was observed after training (455.5 ± 98 versus 557.8 ± 121.0; p = 0.003). No statistically significant difference was observed in the other variables when comparing their pre- and posttraining values. CONCLUSION: The study showed no statistically significant difference in respiratory muscle strength, pulmonary function, and oxygen consumption. An increase in the walked distance was observed in the 6MWT.

"tasa de reducción de la urea" como marcador readecuación en diálisis en pacientes del h o n°2 c n s 2009 / "urea reduction rate" as a marker readjustment in dialysis in patients from h o n ° 2 c n s 2009

La Insuficiencia Renal Crónica Permanente, (IRCP) ha tenido un incremento a nivel mundial, que ha llevado a una crecida demanda de los servicios de diálisis y transplante renal, por lo que es necesario, la introducción de sistemas de monitorización de la dosis real de diálisis "Adecuación" con el fin de prevenir las complicaciones de la uremia crónica y acceder al transplante renal en las mejores condiciones; es por eso que proponemos medir la "Tasa de Reducción de la Urea" (U.R.R) 65-70%. El propósito del estudio es valorar la "Calidad de Diálisis" que prestamos a los pacientes de Diálisis de la C.N.S en sus dos modalidades: Hemodiálisis (HD) y Diálisis Peritoneal (DP), aplicando la U.R.R. con una toma de muestra (Urea pre y pos Diálisis). Es un estudio transversal y descriptivo. En la Unidad de Diálisis son un total de 75 pacientes de los cuales 63 están en HD ,12 en DP. La U.R.R alcanzada en HD fue de 51-69% y >70%, en DP fue < 50%. La mejor U.R.R >70% se alcanzó en el sexo femenino, con 4 hrs, trisemanal, con catéter permanente, con un flujo de bomba (QB) >300, con un rehuso <6 del dializador, con un peso interdialítico < 1 Kg, con una Hb entre 11-13 g/dl, con actividad sin limitaciones según el índice de KARNOFSKY, se asocia a mejor calidad de vida. Más del 60% de los pacientes en nuestro estudio alcanzó una U.R.R. < 70% (KDOQI). Por lo que podemos concluir que la U.R.R. es un instrumento útil para determinar Diálisis Adecuada, pero como valor absoluto único, no correlaciona con el pronóstico de los pacientes, además se recomienda cumplir normas internacionales por demás documentadas con evidencia científica.

The Permanent CKD (IRCP) has been a worldwide increase, which has led to increased demands of dialysis services and kidney transplantation, as necessary, the introduction of systems for monitoring the actual dose dialysis "ade-quacy" in order to prevent the complications of chronic uremia and renal transplantation access in the best conditions, that is why we propose to measure the "rate of urea reduction (URR) 65-70%. The purpose of this study is to assess the "Quality of Dialysis" we provide dialysis patients the CNS on both HD and SD modes, using the URR with sampling (pre and post Diálisis Urea). It is an transversal and descriptive study. In the Dialysis Unit are a total of 75 patients, of whom 63 are in HD, 12 PD. The URR achieved in HD was 51-69% and> 70% by DP was <50%. The best URR> 70% was reached in the female, 4 hrs, three times a week, with a permanent catheter with a pump flow (QB)> 300, with a refuse <6 dialyzer with interdialytic weight <1 kg, with Hb 11-13 g / di, with no activity limitations according to the Karnofsky index, is associated with better quality of life. Over 60% of the patients studied achieved a URR <70% (KDOQI). So we can conclude that the U.R.R. is a useful tool to determine adequate dialysis, but only as an absolute valué, does not correlate with the prognosis of patients also meet international standards recommended by other documented evidence.