Dosis de hemodiálisis sub-óptima: Factores predisponentes, causas y prevención / Inadequate doses of hemodialysis. Predisposing factors, causes and prevention

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.

Simulação numérica e ensaios experimentais da remoção de Fe (III) da água para utilização nas indústrias alimentícias / Numerical simulation and experimental tests of removal of Fe (III) from water for use in food industry

RESUMO Neste estudo foram realizadas as cinéticas e isotermas de adsorção dos íons Fe (III) presentes em afluentes sintéticos utilizando como adsorvente carvão ativado de casca de coco. O objetivo foi a obtenção dos parâmetros cinéticos e de equilíbrio do processo para assim simular diferentes condições operacionais em uma coluna de adsorção em leito fixo. Foram avaliadas a influência de três diferentes temperaturas na adsorção de Fe (III), sendo que o aumento da temperatura indicou adsorção exotérmica. A isoterma de Freundlich representou melhor os dados experimentais. Também foi realizado o estudo cinético e o modelo que apresentou melhor os dados experimentais foi o modelo de Pseudo-Primeira Ordem para as três concentrações estudadas. O método de Volumes Finitos foi utilizado na discretização das equações matemáticas e um algoritmo computacional foi implementado em linguagem FORTRAN. O código computacional foi validado com dados experimentais encontrados na literatura (erro máximo de 6,2%) podendo-se assim simular diferentes condições operacionais do sistema de adsorção com aplicação na indústria alimentícia.

ABSTRACT In this study were performed the kinetics and isotherms of adsorption of the ions Fe (III) from synthetic affluent using activated carbon from coconut shell as adsorbent. The objective was to obtain the equilibrium and kinetic parameters of the process and thereby simulating different operating conditions in a adsorption column fixed bed. It was evaluated the influence of three temperatures different on the adsorption of Fe (III), in which the temperature increase indicated adsorption exotherm. The Freundlich isotherm showed the best fit to the experimental data. At the kinetic study the model that best fit to the experimental data was the model Pseudo-First Order for the three concentrations studied. The finite volume method was used for discretization of the mathematical equations and a computational algorithm was implemented in FORTRAN. The computational code was validated with experimental data found in the literature (maximum error of 6.2%) can thus simulate different operating conditions of the system.