Multicentre study of haemodialysis costs.

BACKGROUND: Previous studies to determine the cost of haemodialysis (HD) in Spain have significant limitations: they are outdated or used indirect methods. There is also a lack of analysis performed simultaneously on Public centres (PC), with direct HD services, and partially state-subsidised centres (SC). This is an important issue since the two systems coexist in Spain. OBJECTIVES: To estimate the cost of HD replacement therapy for chronic renal failure in several centres. METHODS: This is a prospective and publicly-funded study, which estimates the costs for 2008 using a cost accounting system with specific allocation criteria. We collected demographic and comorbidity data for each centre. RESULTS: Six centres participated, two PC and four SC. There were no significant differences between centres in terms of patient demographics, time on haemodialysis and the Charlson comorbidity index. The total cost per patient per year ranged between € 46, 254 and € 33,130. The cost per patient per year (excluding vascular access and hospital admission) for PC was € 42, 547 and € 39, 289 and for SC € 32 872, € 29, 786, € 35, 461 and € 35, 294 (23% more in PC than SC). Costs related to staff/patient/year and consumables/patient/year were 67% and 83% respectively, higher for PC than SC. The highest percentage cost was for staff (average 30.9%), which showed significant variability between centres, both in absolute numbers (staff cost per patient per year between € 18,151 and € 8504) and as a percentage (between 42.6 % and 25.4%). CONCLUSIONS: Cost variability exists among different HD centres, and this can be attributed primarily to staff and consumables costs, which is higher for PC than SC.

[Dispositional optimism in patients on chronic haemodialysis and its possible influence on their clinical course]. / Optimismo disposicional en pacientes en hemodiálisis y su influencia en el curso de la enfermedad.

INTRODUCTION: Dispositional optimism is a personality trait significantly associated with the use of positive adaptive coping strategies as well as with perceived psychological and physical well-being, and it appears to be an important predictor of illness. OBJECTIVES: To analyse if dispositional optimism is significantly associated with the number of hospital admissions of our chronic haemodialysis patients, as well as its relationship with perceived state of health. METHODS: We studied 239 patients on chronic haemodialysis. Patients were categorised into two groups according to the variables: hospital admissions/no. of admissions in the last year and dispositional optimism (DO). We used the following variables and questionnaires: 1) Dispositional O/P using the Spanish-validated cross-cultural adaptation of the revised version of the Life Orientation Test (LOT-R) (Scheier, 1994): higher scores mean a higher degree of dispositional optimism. 2) Health-related quality of life (HRQoL) using the different aspects of the COOP/WONCA (CW) charts and its total score. In this case higher scores mean lower HRQoL. 3) Modified Charlson Comorbidity Index (mCCI). 4) Age, gender, and time on dialysis. RESULTS: Mean age was 64.8 ± 14.3 years; median time on dialysis 2.9 years (range: 0-32); and median LOT-R 21 (range 6-30). Patients considered DO had a lower risk of hospital admissions than pessimists (DP) (OR: 0.55; IC 95%: 0.32-0.94; P<.05). PD Patients that were admitted in the last year showed a significantly lower score on LOT-R (they were more pessimistic) than those that had no hospital admissions (19.4 ± 5.7 vs 22.3 ± 4.6; P=.001). We found no significant differences between admitted and not admitted patients in age, gender, time on haemodialysis and comorbidity. Admitted patients showed worse HRQoL (higher scores in total CW) than those that were not (Total CW: 22.37 vs 19.42; P<.001). PD patients had significantly higher scores than OD patients in all COOP-WONCA aspects except in aspect 1 (physical fitness) and 5 (change in health). CONCLUSIONS: Pessimistic personality trait is significantly associated with hospital admissions in chronic haemodialysis patients, regardless of age, gender and comorbidity. Optimistic patients perceived a better state of health.

Optimismo disposicional en pacientes en hemodiálisis y su influencia en el curso de la enfermedad / Dispositional optimism in patients on chronic haemodialysis and its possible influence on their clinical course

Introducción: El optimismo disposicional es un rasgo de personalidad que se relaciona significativamente con el empleo de estrategias positivas de afrontamiento y con el grado de bienestar psicológico y físico percibidos por el paciente, y que parece ser, también, un importante predictor de enfermedad. Objetivo: Analizar si el optimismo disposicional guarda relación con el número de ingresos hospitalarios que han presentado en el último año los enfermos renales crónicos estadio Vd en nuestros centros. Material y métodos: Se estudiaron 239 pacientes en hemodiálisis que fueron categorizados en dos grupos respecto a las variables ingresos /no ingresos hospitalarios en el último año y optimismo/pesimismo disposicional. Se utilizaron los siguientes cuestionarios y variables: 1) O/P disposicional mediante el LOT–R de Scheier (1994) en su versión española: a mayor puntuación, mayor grado de optimismo disposicional. 2) Calidad de vida relacionada con la salud (CVRS) mediante las láminas COOP/WONCA: a mayor puntuación peor calidad de vida referida. 3) Índice de comorbilidad de Charlson (ICM). 4) Edad, tiempo en HD y sexo. Resultados: La edad media fue de 64,8 ± 14,3 años; la mediana de tiempo en hemodiálisis de 2,9 años (rango: 0–32), y la mediana en el LOT–R 21 (rango: 6–30). Los pacientes optimistas (OD) presentaban un menor riesgo de ser ingresados que los pesimistas (PD) (OR: 0,55; IC 95%: 0,32–0,94; p <0,05) y los pacientes con ingresos hospitalarios (..) (AU)

Introduction: Dispositional optimism is a personality trait significantly associated with the use of positive adaptive coping strategies as well as with perceived psychological and physical well–being, and it appears to be an important predictor of illness. Objectives: To analyse if dispositional optimism is significantly associated with the number of hospital admissions of our chronic haemodialysis patients, as well as its relationship with perceived state of health. Methods: We studied 239 patients on chronic haemodialysis. Patients were categorised into two groups according to the variables: hospital admissions/no. of admissions in the last year and dispositional optimism (DO). We used the following variables and questionnaires: 1) Dispositional O/P using the Spanish–validated cross–cultural adaptation of the revised version of the Life Orientation Test (LOT–R) (Scheier, 1994): higher scores mean a higher degree of dispositional optimism. 2) Health–related quality of life (HRQoL) using the different aspects of the COOP/WONCA (CW) charts and its total score. In this case higher scores mean lower HRQoL. 3) Modified Charlson Comorbidity Index (mCCI). 4) Age, gender, and time on dialysis. Results: Mean age was 64.8±14.3 years; median time on dialysis 2.9 years (range: 0–32); and median LOT–R 21 (range 6–30). Patients considered DO had a lower risk of hospital admissions than pessimists (..) (AU)

Captores del fósforo: preferencias de los pacientes en hemodiálisis y su repercusión sobre el cumplimiento del tratamiento y el control del fósforo / Phosphorus binders: preferences of patients on haemodialysis and its impact on treatment compliance and phosphorus control

Introducción: En la actualidad disponemos de un amplio abanico de captores del fósforo (CF), pero sabemos poco acerca de las preferencias de los pacientes y de su repercusión sobre el cumplimiento del tratamiento y el control de los niveles de fósforo. Objetivo: Estudiar las preferencias y creencias de los pacientes respecto a los CF, y su influencia sobre el cumplimiento del tratamiento y el control de los niveles de fósforo. Pacientes y métodos: Estudio observacional transversal. Se incluyeron 121 pacientes que respondieron un cuestionario genérico de cumplimiento del tratamiento (SMAQ) y a un cuestionario específico sobre cumplimiento del tratamiento con CF, tipo de CF preferido y razones de dicha preferencia. Todos los pacientes entrevistados habían probado dos o tres CF. Las consecuencias de la falta de cumplimiento del tratamiento con CF se estimaron indirectamente analizando los valores promedio de fósforo sérico. Resultados: El 40% de los pacientes era incumplidor según el cuestionario SMAQ; se encontró una asociación estadísticamente significativa entre la falta de cumplimiento en general y no alcanzar el objetivo de fósforo sérico promedio <5,5 mg/dl (OR = 4,8; IC 95%, 1,0-6,6; p = 0,02). El 21,4% de los pacientes reconocía un incumplimiento específico para los CF; estos pacientes presentaban una mayor probabilidad de tener cifras medias de fósforo >5,5 mg/dl (OR = 4,7; IC 95%, 1,1-6,5; p = 0,03). Un 43,8% de los pacientes no refirió tener preferencias entre los diferentes tipos de CF; para el resto de pacientes, el CF preferido fue Royen(R), seguido de Fosrenol(R), Renagel(R) y Pepsamar(R). Las razones expresadas para el desagrado con el Renagel® fueron las siguientes: incomodidad en la toma por su gran tamaño (28,8%), necesidad de tomar muchos comprimidos y gran consumo de agua (57,7%) e intolerancia gástrica (13,3%). En el caso del Fosrenol(R) incómodo de tomar (72,7%) e intolerancia gástrica (27,2%); para el Pepsamar(R): mal sabor (54,5%) e intolerancia gástrica (45,4%). Sólo al 9,4% no le gustaba el Royen(R). Al analizar los conocimientos de los pacientes respecto a la utilidad de los CF, un 42% sabía que servían para controlar el fósforo; un 52% no lo sabía y un 6% tenía ideas equivocadas. En cuanto a su importancia: un 47% no conocía por qué son importantes; un 2% tenía ideas erróneas; un 9% creía que era beneficioso para la salud; un 11% creía que era bueno «porque lo dice el medico»; un 26% porque controla el fósforo y un 5% lo relacionaba con el hueso. Ningún paciente relacionó los CF con la enfermedad cardiovascular. Un 24,4% no se llevaba los CF cuando salía fuera de casa o estaba con los amigos; eran pacientes más jóvenes a quienes se les habían prescrito un mayor número de comprimidos de CF y que presentaban un mayor riesgo de no cumplir el objetivo de fósforo (OR = 10,5; IC 95%, -1,8 a -16,4; p <0,001). El porcentaje de pacientes a quienes no les gustaba el CF prescrito fue del 54,5%; dichos pacientes presentaban un mayor riesgo de tener niveles séricos de fósforo >5,5 mg/dl (OR = 13.3; IC 95%, 1,1-1,5; p = 0,0001). Paradójicamente, los pacientes que no cumplían con el tratamiento demostraban un mejor conocimiento de su uso (OR = 17,3; IC 95%, 2,2-10,1; p <0.0001) e importancia (OR = 10,4; IC 95%, 1,5-6,6; p = 0,001). Conclusión: Los pacientes a los que se les habían prescrito CF que no les gustaban tenían un peor control de los niveles de fósforo sérico y se les habían recomendado dosis más altas de los fármacos. El conocimiento de las preferencias de los pacientes acerca de las medicaciones que se les prescriben puede ser un factor esencial para conseguir un mayor cumplimiento del tratamiento y, por ende, lograr mejores resultados en la consecución de los objetivos terapéuticos (AU)

Introduction: Non-adherence to phosphate binding (PB) medication may play a role in the difficulty in achieving the targets for phosphorus. We have a wide spectrum of PB but preferences of patients are poorly understood. Objective: to study the patients’ preferences and beliefs regarding PB and their influence on adherence and serum phosphate. Methods: A cross-sectional cohort study was performed. A total of 121 hemodialysis patients answered a specific questionnaire in which they were questioned about adherence, the type of PB they preferred and the reasons for their choice. All patients questioned tasted two or three PB. The consequence of non-adherence to PB was estimated indirectly by determination of serum phosphorus. Results: Specific noncompliance with PB medication was recognized by 21.4% of patients. Patients non-adherent specifically to PB were more likely to have P levels >5.5 mg/dl (χ2: 4.7; 95% CI 1.07-6.5; p = 0.03). Paradoxically, non-adherent patients showed greater knowledge of the use (χ2: 17.3; 95% CI -2.2-10.1; p <0.0001) and importance of the drug (χ2: 10.4; 95% CI -1.5-6.6; p = 0.001). The percentage of patients prescribed binders that they did not like was 54.5%. Patients who were taking PB that they did not like had a greater risk of having P levels >5.5 mg/dl) (χ2: 13.3; 95% CI -1.1-1.5; p = 0.0001). Calcium acetate was the prefered PB in 47.1% of patients, lanthanum carbonate in 40%, sevelamer in 20.6% and aluminum hydroxide in 19.4%. The reasons claimed by patients for their negative ratings of PB were the type of dosage form, the taste, the number of tablets and gastric intolerance. Gastric intolerance and bad taste were more frequent in aluminum hydroxide patients (19.4% and 22.2%, respectively). Sevelamer received complaints about its dosage form because the tablets were too large and a large number of tablets were required (27.2%). 17.7% of patient who were taking lanthanum carbonate did not like the chewable tablets. Conclusion: patients who were taking binders that they did not like had worse serum P levels and were prescribed higher doses of binders. Knowing patients' preferences about the drugs prescribed may be a key factor in achieving adequate adherence to treatment (AU)

[Phosphorus binders: preferences of patients on haemodialysis and its impact on treatment compliance and phosphorus control]. / Captores del fósforo: preferencias de los pacientes en hemodiálisis y su repercusión sobre el cumplimiento del tratamiento y el control del fósforo.

INTRODUCTION: Non-adherence to phosphate binding (PB) medication may play a role in the difficulty in achieving the targets for phosphorus. We have a wide armamentarium of PB but preferences of patients are poorly understood. OBJECTIVE: to study the patients' preferences and beliefs regarding PB and their influence on adherence and serum phosphate. METHODS: A cross-sectional cohort study was performed. A total of 121 hemodialysis patients answered a specific questionnaire in which they were questioned about adherence, the type of PB they preferred and the reasons for their choice. All patients questioned tasted two or three PB. The consequence of non-adherence to PB was estimated indirectly by determination of serum phosphorus. RESULTS: Specific noncompliance with PB medication was recognized by 21.4% of patients. Patients non-adherent specifically to PB were more likely to have P levels >5.5 mg/dl (χ(2): 4.7; 95% CI 1.07-6.5; p = 0.03). Paradoxically, patients non-adherent showed greater knowledge of the use (χ(2): 17.3; 95% CI -2.2-10.1; p <0.0001) and importance of the drug (χ(2): 10.4; 95% CI -1.5-6.6; p = 0.001). The percentage of patients prescribed binders they did not like was 54.5%. Patients who were taking PB they did not like had a greater risk of having P levels >5.5 mg/dl) (χ(2): 13.3; 95% CI -1.1-1.5; p = 0.0001). Calcium acetate was the preferred PB in 47.1% of patients, lanthanum carbonate in 40%, sevelamer in 20.6% and aluminum hydroxide in 19.4%. The reasons claimed by patients for their negative ratings of PB were the type of dosage form, the taste, the number of tablets and gastric intolerance. Gastric intolerance and bad taste were more frequent in aluminum hydroxide patients (19.4% and 22.2%, respectively). Sevelamer received complaints about its dosage form because the tablets were too large and a large number of tablets were required (27.2%). 17.7% of patient who were taking lanthanum carbonate did not like the chewable tablets. CONCLUSION: patients who were taking binders that they did not like had worse serum P levels and were prescribed higher doses of binders. Knowing patients' preferences about the drugs prescribed may be a key factor in achieving adequate adherence to treatment.

Ancianos con hipertensión arterial esencial y filtrado glomerular disminuido: seguimiento de la función renal a los 24 meses / The elderly with essential high blood pressure and decreased glomerular filtration rate: a kidney function follow-up at 24 months

Introducción y Objetivo: La prevalencia de la hipertensión arterial (HTA) en los ancianos es elevada. Su falta de control supone un factor de riesgo para la progresión del daño renal, siendo la HTA junto con la diabetes mellitus las principales causas de insuficiencia renal crónica (IRC). Analizamos la evolución de la función renal (FR) de ancianos con HTA a los 24 meses, considerando la influencia de la FR previa. Pacientes y métodos: Estudiamos a 66 ancianos con una edad media al comienzo del estudio de 82,3±6 años (rango 69–97), siendo varones un 24,2%, estables clínicamente, diagnosticados de HTA esencial. Los pacientes son valorados inicialmente entre enero-abril 2006 y seguidos prospectivamente durante 24 meses. Los ancianos procedían de consultas de Geriatría y Nefrología General y fueron seguidos durante el periodo de estudio por dichos servicios. Según las cifras basales de creatinina sérica (Crs), establecimos dos grupos: grupo 1 (n=30, Crs<=1,1mg/dl) y grupo 2 (n=36, Crs>1,1mg/dl). Registramos el número y tipo de agentes antihipertensivos utilizados al inicio del estudio y a los 24 meses, así como la presión arterial (PA) ambulatoria previa a la consulta. Analizamos en sangre: creatinina, urea, úrico, y estimamos el filtrado glomerular (FG) con fórmulas de Cockroft-Gault y MDRD abreviado. La estadística se hace con SPSS 11.0, usando un modelo lineal general para medidas repetidas, significación p<0,05. Resultados: Los parámetros de FR analizados de forma global permanecen sin cambios significativos con el paso del tiempo: (basal/24 meses: creatinina (mg/dl): 1,26±0,48/1,26±0,46 (no significativo); urea (mg/dl): 58,52±29/61,52±30 (no significativo); úrico (mg/dl): 5,94±1/6,13±1 (no significativo); FG (Cockroft) (ml/min): 41,33±13/40,32±14 (no significativo); FG (MDRD) (ml/min): 51,23±15/51,45±16 (no significativo). (..) (AU)

Introduction and objective: There prevalence of high blood pressure (HBP) in the elderly is high. Its lack of control is a risk factor for progression of kidney damage. HBP and Diabetes Mellitus are the principal causes of chronic renal failure (CRF). We have analyzed the evolution of the renal function (RF) in the elderly with HBP at 24 months, taking the influence of the previous RF into account. Patients and methods: A total of 66 clinically stable elderly subjects with essential HBP, average age 82.3±6 years (range 69–97) at the onset of the study, 24.2% men, were studied. The patients were evaluated initially between January-April, 2006 and followed-up for 24 months. The elderly subjects came from Geriatrics and General Nephrology Departments and were followed-up by the Departments in question during the study period. We established two groups according to the baseline serum creatinine values: group 1: N=30, serum creatinine <=1.1mg/dl and group 2 N=36, serum creatinine >1.1mg/dl. Number and type of antihypertensive agents used at baseline and at 24 months and ambulatory blood pressure (BP) levels prior to the medical visit were recorded. The following were measured in blood: creatinine, urea, and uric acid and glomerular filtration rate (GFR) were calculated with the Cockroft-Gault and abbreviated MDRD formulas. Statistics were obtained with the SPSS 11.0 using a generalized linear model with repeated measures, significance, p<0.05. Results: The RF parameters, when analyzed globally, showed no significant changes over time: (baseline/24 months: serum Creatinine (mg/dl): 1.26±0.48/ 1.26±0.46 (non-significant); urea (mg/dl): 58.52±29/61.52±30 (non-significant); uric acid (mg/dl): 5.94±1 /6.13±1 (non-significant); GFR (Cockroft) (ml/min): 41.33±13 / (..) (AU)

Fracaso renal agudo en un paciente con carcinoma renal tratado con Temsirolimus / No disponible

No disponible

Respuesta clínica al tratamiento con iloprost en paciente con enfermedad por ateroembolismo de colesterol / No disponible

No disponible

Nephrotic syndrome as paraneoplastic manifestation of a primary pulmonary lymphoepithelioma-like carcinoma.

We present a case of nephrotic syndrome secondary to a membranous glomerulonephritis (MG), in a nonsmoking female with a solitary pulmonary nodule, which did not show growth during 2 years of followup. A biopsy by videothoracoscopy showed a granulomatous non-neoplastic process with giant multinucleated cells. The appearance of a nephrotic syndrome and its interpretation as paraneoplastic revealed the existence of a primary pulmonary lymphoepithelioma-like carcinoma (LELC), a very rare pulmonary tumor. After resection of tumor there was a complete recovery from the nephrotic syndrome. This case highlights how the investigation of paraneoplastic syndromes can help in the early diagnosis of some malignancies.

[Can FT3 levels facilitate the detection of inflammation or catabolism and malnutrition in dialysis patients?]. / ¿Pueden los niveles de T3L facilitar la detección de estados inflamatorios o de catabolismo y desnutrición en enfermos en diálisis?

INTRODUCTION: Low serum free triiodothyronine (FT3) levels have been reported in a high percentage of chronic renal failure (CRF) patients and have been considered as independent predictors of mortality in both hemodialysis (HD) and peritoneal dialysis (PD). A reduction in thyroid function in dialysis patients could be a marker of malnutrition and/or inflammation. OBJECTIVE: Our aim has been to evaluate the incidence of low T3 syndrome in a group of dialysis patients and analyze its relationship with different parameters of malnutrition and inflammation. PATIENTS AND METHODS We included 32 stable dialysis patients (24 HD and 8 DP); mean age +/- SD 71.2 +/- 11.7 years; 46.9% males; 15.6% diabetics; mean time on dialysis 47 +/- 43 months. The following parameters were measured in every patient: thyrothropin (TSH), Free T4 (FT4) and Free T3 (FT3); biochemical data related to nutritional status; anthropometric measurements, bioelectrical impedance vector analysis (BIVA), and dietary survey of three consecutive days. Statistical analysis was performed by using SPSS 11.0. RESULTS: Mean hormonal values of thyroid function were: TSH 2,2 +/- 1.5 U/ml (range: 0,4-5.0); FT4 14.7 +/- 2.3 pmol/l (range: 11.0-23.0) and FT3 4,0 +/- 0.71 pmol/l (range: 3.95-6.80). Only 2 patients (6.3%) showed low FT4 levels and another 2 patients increased TSH levels, whereas 17 patients (53.1%) presented with low FT3 levels. We did not found any correlation between serum FT3, FT4 and TSH levels. We found a correlation between FT3 and inflammation/nutritional parameters: prealbumin (r = 0,36; p = 0,04); transferrin (r = 0,40; p = 0,025); PCR (r = -0.38; p = 0,039); and IGF-I (r = 0,38; p = 0,03); body mass index (BMI) (r = 0,51; p = 0,002); arm circumference (AC) (r = 0,65; p = 0,000), and arm muscle circumference (AMC) (r = 0,72; p = 0,000). FT3 levels were also correlated with BIVA parameters: phase angle (r = 0,54; p = 0,002); muscle mass percentage (r = 0,49; p = 0,005); and cell mass percentage (r = 0,53; p = 0,02), but not with any data of fat mass. AMC was the only variable that independently correlated with FT3 levels in the multivariate regression analysis (r = 0,69; r2: 0,48; p = 0,000) CONCLUSION: Half of our dialysis patients have decreased levels of serum FT3 without alteration on FT4 or TSH. Low FT3 levels are correlated bioquimical and anthropometric parameters indicators of malnutrition and inflammation. Periodical measurement of FT3 levels could be used by clinicians as an accesible and reproducible method to detect such states.

[Operation to remove tunnelled venous catheters in a dialysis unit. Is it possible to reverse the trend in their growing use?]. / Operación retirada de catéteres venosos tunelizados en una unidad de diálisis. ¿Es posible cambiar la tendencia en el uso creciente de éstos?

INTRODUCTION: Introduction In an attempt to reduce unnecessary central venous catheters (CVC) dependence in prevalent population, a "CVC removal" programme was initiated in our unit. The objective was to diminish the number of CVC and to analyze the causes of their insertion and maintenance. On 09/01/07, 38 out of 173 prevalent patients on hemodialysis. Methods were CVC dependant (21.9%): 16 incident patients (42,1%) and 22 (57,8%) prevalent patients. All of them were re-evaluated for permanent vascular access utilization, included those previously rejected for surgery. Physical, psychical and vascular aspects regarding each patient were taken into consideration. The following variables were age, Body mass index, time on hemodialysis, Charlson analyzed comorbidity index, DM or vascular comorbidities and number of vascular accesses created prior to CVC placement. In those patients in whom AVF creation was feasible, the following were registered after 18 months of 1.Primary failure rate. 2. Related complications. 3. up follow Percentage of usable AVF or AVG. 4. Percentage of removed CVC. 5. Mortality and hospitalization. The decision of no realization of a new vascular access and? Results maintenance of TVC was performed in 21 patients (55.2%). In 9 of them was decision of the nephrologists and the family. In 11 patients was decision of vascular surgeon due to vascular bed exhaustion. A permanent VA was achieved in 17 patients (44.7%), 50% of them was incident patients and 45% prevalent patients. The primary failure rate was 0%. The TVC was withdrawn in 11/17 (64.7%). Only 4 patients remain without TVC after 18 months of follow-up: 5 patients died (4 with a AVF functioning and 1 VA closure due to steal syndrome) and in 8 patients was mandatory to reintroduce the TVC again. Immediate complications after the surgery were: 1 severe haematoma, 2 infections and 2 severe sequestrations. 3 patients required hospital admission following complications directly related to VA. Mean time of free of TVC was 5.2 months (range: 0.7- 14.3 months). The mortality was 29,4% (5/17) in the group of patients with a new VA and 9,5% (2/21) in the other group(RR 3,19; IC 95%: 0,68-13,98; p: 0,11). No significant differences were observed between patients who transitioned to a permanent vascular access and those who remained TVC dependant in regards to age, gender, BMI, time on dialysis, DM, comorbidity or number of previous VA, Transition from CVC use to hospitalizations or mortality. Conclusions permanent vascular access is possible in prevalent patients in dialysis. Improvement was achieved by a modest amount, and after a prolonged process with gravel complications, some of which proved severe. Need for CVC dependence is confirmed in a high percentage of prevalent patients on dialysis. Comorbidity might have influenced the results. The quality standard should be adequate to reality of current population on hemodialysis.

[Elderly patients with chronic kidney disease: what happens after 24 months of follow-up]. / Ancianos con enfermedad renal crónica: ¿qué ocurre a los 24 meses de seguimiento?

INTRODUCTION: Systematic application of mathematical formulae to estimate the glomerular filtration rate (eGFR) of the general population, according to KDOQI classification of Chronic Kidney Disease (CKD), has permitted to calculate its high prevalence, so as to be considered as a public health problem. Many patients with CKD according to this classification (at least stage 3) are elderly with a low GFR and without any other typical manifestations of renal damage, which is generating a worry between nephrologists due to a significant increment in non justified referrals to their clinics. Our aim in this study is to follow-up during twenty-four months a group of elderly with a low eGFR. PATIENTS AND METHODS: 80 clinically stable patients, with a mediane age of 83 years (range 69-97), recruited alleatory in a consultation of Geriatric and Nephrology General, within January and April 2006, were followed up during twenty-four months. We separated them in two groups based in serum creatinine: Group 1: 38 patients with serum creatinine >_ 1,1 mg/dl (range 0,7-1,1), and Group 2: 42 patients with serum creatinine >1.1 mg/dl (range 1,2-3). Clinically we registered morbimortality and treatments received, and biochemically we measured in serum: creatinine and calculated eGFR at the time of recruitment and after twenty-four months of follow-up using two equations: Cockroft and abreviated MDRD. In urine we determinated basic urinalysis in all patients, protein/creatinine in group 1 and determinated protein in collection urine 24 hours group 2. Statistical comparisons were made using repeated measures, chisquare, and logistic regression of the SPSS 11.0 program. RESULTS: 22,5% of the patients died during the follow up. Heart and infectious problems were the kind of morbidity more frequently found. Only a small proportion (23,3%) of group 2 patients were receiving erithropoietin treatment. Estimated GFR and proteinuria remained stable at the end of twenty-four months independently of basal eGFR. We found no significant differences between both groups in the rest of analytical parameters studied except a significant decrease of hematocrit in the elderly of group 2. Only a small proportion (23,3%) of group 2 patients were receiving erithropoietin treatment. CONCLUSION: In old patients without proteinuria, the stability of its renal function along the time allows us to give a soothing message at the moment of facing the so called CKD "epidemic" in this population.